Individual
COLTON BRAD PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4403 HARRISON BLVD STE 2400, OGDEN, UT 84403-3297
(801) 387-2750
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11306023-1206
UT
Other
Enumeration date
06/24/2019
Last updated
10/25/2019
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