Healthcare Provider Details

I. General information

NPI: 1265827893
Provider Name (Legal Business Name): CACEY WILLIAM PETERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
SAINT GEORGE UT
84790-2123
US

IV. Provider business mailing address

1430 TULANE AVE # SL-79
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number67275
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number12888572-1235
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: