Hathaway, Peter Blaine

Hathaway, Peter Blaine is an individual health care provider with primary practice located at 1433 N 1075 W Ste 104 , Farmington UT 84025-2746. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Hathaway, Peter Blaine can be contacted via phone (801) 298-1300.

Contact Information

Primary practice address
1433 N 1075 W Ste 104 Farmington UT 84025-2746
Phone: (801) 298-1300
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 372564-1205 Utah
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 372564-1205 Utah

Profile Details

NPI number 1730187824
LBN Legal business name Hathaway, Peter Blaine
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Feb 19th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730187824 NPPES
Idaho MEDICAID 8067535
Idaho MEDICAID 002089152
Idaho Other P00196218
Idaho MEDICAID 120828400
Idaho MEDICAID 4456436
Idaho MEDICAID 927733
Idaho Other P00651533
Idaho MEDICAID D2916

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