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General NPI Number Information
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NPI Number | 1346237393
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Entity Type | Individual
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Provider Name | RYAN PAUL PETERSON DO
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 1553 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-9219
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Country | US
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Telephone | 801-563-0300
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Fax | 801-565-4690
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Provider Business Mailing Address
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Address Line | 2685 S RAINBOW BLVD SUITE 112
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City | LAS VEGAS
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State | NV
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Zip | 89146-5182
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Country | US
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Telephone | 801-563-0300
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Fax | 801-565-4690
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5683991-1204
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License Number State | UT
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