Individual
RUSSELL S 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
91-184977-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002086882
—
NV
01
—
107006198101
IHC
UT
05
—
112774800
—
WY
01
—
1502954
UMWA
UT
01
—
2090168
UNITED HEALTHCARE
UT
01
—
53263
HEALTHY U
UT
01
—
538587317
MAILHANDLERS
UT
01
—
73574
PEHP
UT
01
—
756601
DESERET MUTUAL
UT
05
—
804075500
—
ID
05
—
840935
—
AZ
01
—
870545614PE1
EDUCATORS MUTUAL
UT
01
—
PRA04891
MOLINA
UT
01
—
QM0000075886
ALTIUS
UT
Enumeration date
08/31/2006
Last updated
10/15/2012
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