Michael J. Peterson M.D LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5354110-1205 Issued in UT

Legal business name

MICHAEL J. PETERSON M.D LLC

Practice address

5746 W 13400 S
Herriman, UT 84096-6907

Phone

(801) 253-4001

Fax

(801) 253-4003

NPI assigned

Jan 9, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael J Peterson, M.D.

Title

Owner/Physician

Phone

(801) 253-4001

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• HERRIMAN FAMILY MEDICINE Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1275718280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5746 W 13400 S",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840966907",
            "telephone_number": "801-253-4001",
            "fax_number": "801-253-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5746 W 13400 S",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840966907",
            "telephone_number": "801-253-4001",
            "fax_number": "801-253-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. PETERSON M.D LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "801-253-4001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5354110-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079585401001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HERRIMAN FAMILY MEDICINE",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Family Medicine Physician in Herriman, UT
• Providers in Herriman, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.