Healthcare Provider Details

I. General information

NPI: 1316962442
Provider Name (Legal Business Name): JAMES T. PETERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

IV. Provider business mailing address

2295 FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-3021
  • Fax: 801-485-6339
Mailing address:
  • Phone: 801-486-3021
  • Fax: 801-485-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30866461205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number30866461205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: