NPIMap

Organization Active NPI

J. Dayne Petersen M.D., PC

  • Medical Specialty Clinic/Center
  • Salt Lake City, UT
National Provider Identifier
1346597507
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
83185641205 Issued in UT
Legal business name
J. DAYNE PETERSEN M.D., PC
Doing business as
NuVista Plastic Surgery
Practice address
5353 S 960 E
#150
Salt Lake City, UT 84117-3569
Phone
(801) 261-5791
Fax
(801) 747-7740
NPI assigned
Aug 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Authorized official

Name
Dr. Jason Dayne Petersen, M.D.NPI 1215105804
Title
President
Phone
(801) 971-8684

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 83185641205 UT Primary

Addresses

Primary practice location

5353 S 960 E
#150
Salt Lake City, UT 84117-3569

Mailing address

5353 S 960 E
#150
Salt Lake City, UT 84117-3569
Phone (801) 261-5791

Other names 1

  • NuVista Plastic Surgery Doing business as

National Provider Directory

National Provider Directory

Locations

5353 S 960 E
Ste 150
Murray, UT 84117
Phone (801) 261-5791

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346284800000",
    "number": "1346597507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5353 S 960 E",
            "address_2": "#150",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841173569",
            "telephone_number": "801-261-5791",
            "fax_number": "801-747-7740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 S 960 E",
            "address_2": "#150",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841173569",
            "telephone_number": "801-261-5791",
            "fax_number": "801-747-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. DAYNE PETERSEN M.D., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-08-30",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-971-8684",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "UT",
            "license": "83185641205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NuVista Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; 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.