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General NPI Number Information
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NPI Number | 1245486307
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Entity Type | Individual
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Provider Name | RYAN THOMAS PETERSON DPM
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Gender | Male
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 2019 E RIVERSIDE DR STE A101
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City | ST GEORGE
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State | UT
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Zip | 84790-8147
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Country | US
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Telephone | 801-253-6888
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Fax | 385-900-5928
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Provider Business Mailing Address
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Address Line | 9980 S 300 W STE 300
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City | ST GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 801-273-0001
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Fax | 385-900-5928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1104
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 7930013-0501
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License Number State | UT
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