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NPI Code Detail

MEDICARE: ANDREW D PETERSEN DO

MEDICARE: ANDREW D PETERSEN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianM4441TX
2207Q00000XFamily Medicine Physician8382699-1204UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2207Q00000XOTHERKSTAXONOMY

General Provider Information

NPI Number : 1124011572
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW D PETERSEN DO
Provider Business Mailing Address
First Line : 524 W 300 N STE 203
Second Line :
City : PROVO
State : UT
Zip : 84601-2669
Country : US
Telephone Number : 801-607-5268
Fax Number : 801-607-5271
Provider Business Practice Location Address
First Line : 524 W 300 N STE 203
Second Line :
City : PROVO
State : UT
Zip : 84601-2669
Country : US
Telephone Number : 801-607-5268
Fax Number : 801-607-5271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 05/21/2014

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Directions to “ ANDREW D PETERSEN DO” Practice Location

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