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General NPI Number Information
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NPI Number | 1316998560
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCED PLASTIC SURGERY
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 676 S BLUFF ST SUITE 207
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City | ST GEORGE
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State | UT
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Zip | 84770-3596
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Country | US
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Telephone | 435-628-2895
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Fax | 435-628-5943
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Provider Business Mailing Address
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Address Line | 676 S BLUFF ST SUITE 207
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City | ST GEORGE
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State | UT
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Zip | 84770-3596
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Country | US
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Telephone | 435-628-2895
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Fax | 435-628-5943
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARCUS L PETERSON
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Credential | MD FACS
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Telephone | 435-628-2895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 345016
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License Number State | UT
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