MEDICARE: DR. LESLIE PETERSON ND

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
1	175F00000X	Naturopath	350301-7100	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350301-7100	OTHER	UT	UTAH STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1235211202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE PETERSON ND

Provider Business Mailing Address
First Line	:	5107 S 900 E STE 140
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-6630
Country	:	US
Telephone Number	:	801-746-3555
Fax Number	:	801-746-3556

Provider Business Practice Location Address
First Line	:	5107 S 900 E STE 140
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-6630
Country	:	US
Telephone Number	:	801-746-3555
Fax Number	:	801-746-3556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	06/10/2020

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Directions to “ DR. LESLIE PETERSON ND” Practice Location

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