Peterson, Brian R

Peterson, Brian R is an sole proprietor health care provider with primary practice located at 3584 W 9000 S Suite 311, West Jordan UT 84088-5710. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Otology & Neurotology. Allopathic & Osteopathic Physicians / Otology & Neurotology is his primary health care specialty. Peterson, Brian R can be contacted via phone (801) 566-8304.

Contact Information

Primary practice address
3584 W 9000 S Suite 311 West Jordan UT 84088-5710
Phone: (801) 566-8304
Fax: (801) 566-8304
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 036142390 Illinois
Allopathic & Osteopathic Physicians / Otology & Neurotology 207YX0901X 313974-1205 Utah

Profile Details

NPI number 1316978687
LBN Legal business name Peterson, Brian R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 5th, 2006
Last updated Nov 2nd, 2020 - 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 1316978687 NPPES
Illinois Other 214881 MEDICARE GROUP PTAN

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