Individual
SHANE L PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5121 S COTTONWOOD STREET, INTERMOUNTAIN MEDICAL CENTER, MURRAY, UT 84157
(801) 507-5248
(801) 733-5618
Mailing address
3340 NORTH CENTER ST #800, LEHI, UT 84043-7406
(801) 990-1911
(801) 990-1912
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2434068-1205
UT
207L00000X
Anesthesiology Physician
MD227949
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506343
—
NV
01
—
107038030101
IHC
UT
05
—
121124200
—
WY
01
—
1502954
UMWA
UT
01
—
2090168
UNITED HEALTHCARE
UT
01
—
24340681200001
REGENCE BCBS
UT
05
—
807171600
—
ID
01
—
83770
PEHP
UT
01
—
907869
DESERET MUTUAL
UT
05
—
941379
—
AZ
01
—
99469
HEALTHY U
UT
01
—
QM0000075886
ALTIUS
UT
01
—
QMP000003262280
MOLINA
UT
Enumeration date
08/08/2006
Last updated
12/29/2025
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