Individual
BRYAN J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5475 S 500 E, OGDEN, UT 84405-6905
(800) 880-3566
(801) 733-5872
Mailing address
1954 FORT UNION BLVD STE 106, SALT LAKE CITY, UT 84121-6890
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
96-321407-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007919103
IHC
UT
01
—
2000026
UNITED HEALTHCARE
UT
01
—
219504
ALTIUS
UT
01
—
52186
HEALTHY U
UT
01
—
561586
CIGNA
UT
01
—
581710
DESERET MUTUAL
UT
01
—
68295
PEHP
UT
01
—
870458780PE1
EDUCATORS MUTUAL
UT
01
—
PR00532
MOLINA
UT
Enumeration date
08/10/2006
Last updated
07/08/2007
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