Individual
DR. MARTA J PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-1100
(801) 581-2955
Mailing address
PO BOX 3208, SALT LAKE CITY, UT 84110-3208
(801) 587-6340
(801) 587-6346
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1664261205
UT
207NS0135X
Procedural Dermatology Physician
1664261205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002089156
—
NV
05
—
003054200
—
ID
01
—
070004834
RR MEDICARE PROVIDER #
—
05
—
870468377001
—
UT
05
—
J0854
—
NM
05
—
XPY117280
—
CA
Enumeration date
09/20/2006
Last updated
11/11/2021
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