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NPI Code Detail

MEDICARE: DONN PETERS PSYD PC

MEDICARE: DONN PETERS PSYD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency312303-2501UT

General Provider Information

NPI Number : 1598971889
Entity Type Code : Organization
Provider Name (Legal Business Name) : DONN PETERS PSYD PC
Provider Business Mailing Address
First Line : 900 BITNER RD
Second Line : K-33
City : PARK CITY
State : UT
Zip : 84098-5404
Country : US
Telephone Number : 435-644-9683
Fax Number :
Provider Business Practice Location Address
First Line : 2024 SIDEWINDER DR
Second Line :
City : PARK CITY
State : UT
Zip : 84060-7365
Country : US
Telephone Number : 435-649-6838
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DONN W PETERS
Credential : PSY.D.
Telephone Number : 435-649-6838
Provider Enumeration Date : 05/15/2007
Last Update Date : 08/22/2020

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