Petersen, Andrew D
Petersen, Andrew D is an individual health care provider with primary practice located at 524 W 300 N Ste 203 , Provo UT 84601-2669. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Petersen, Andrew D can be contacted via phone (801) 607-5268.Contact Information
Primary practice address
524 W 300 N Ste 203
Provo UT 84601-2669
Phone: (801) 607-5268
Fax: (801) 607-5271
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M4441 | Texas |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 8382699-1204 | Utah |
Profile Details
| NPI number | 1124011572 |
|---|---|
| LBN Legal business name | Petersen, Andrew D |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2005 |
| Last updated | May 21st, 2014 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124011572 | NPPES |
| Texas | MEDICAID | 184033201 | |
| Texas | Other | 207Q00000X |
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