Healthcare Provider Details

I. General information

NPI: 1801968359
Provider Name (Legal Business Name): DAVID SCOTT PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 EAST 3900 SOUTH STE 208
SALT LAKE CITY UT
84124-4416
US

IV. Provider business mailing address

1345 EAST 3900 SOUTH STE 208
SALT LAKE CITY UT
84124-4416
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-1788
  • Fax: 801-281-2788
Mailing address:
  • Phone: 801-281-1788
  • Fax: 801-281-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number3629291205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number3629291205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: