Petersen, Gary

Petersen, Gary is an individual health care provider with primary practice located at 1380 E Medical Center Dr Ste # 4100, St George UT 84790-2156. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Petersen, Gary can be contacted via phone (435) 251-2900.

Contact Information

Primary practice address
1380 E Medical Center Dr Ste # 4100 St George UT 84790-2156
Phone: (435) 251-2900
Fax: (435) 251-2916
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 154580-1205 Utah

Profile Details

NPI number 1295775971
LBN Legal business name Petersen, Gary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2006
Last updated Sep 5th, 2008 - about 16 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 1295775971 NPPES
Utah MEDICAID 100507061

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