Healthcare Provider Details

I. General information

NPI: 1215327762
Provider Name (Legal Business Name): SARAH PETTYJOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5334 S WOODROW ST STE 100
MURRAY UT
84107-5838
US

IV. Provider business mailing address

5334 S WOODROW ST STE 100
MURRAY UT
84107-5838
US

V. Phone/Fax

Practice location:
  • Phone: 801-713-0600
  • Fax: 801-713-0601
Mailing address:
  • Phone: 801-713-0600
  • Fax: 801-713-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14223129-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: