Active NPI
Gary L Peterson, DVM
- Veterinarian
- Salt Lake City, UT
National Provider Identifier
1417299074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Veterinarian
- License
- 109676-2801
- Practice address
- 1220 S State St
Salt Lake City, UT 84111-4535 - Phone
- (801) 328-8543
- Fax
- (801) 364-1803
- NPI assigned
- Mar 21, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Veterinarian | 174M00000X | 109676-2801 | UT | Primary |
Addresses
Primary practice location
1220 S State St
Salt Lake City, UT 84111-4535
Mailing address
1220 S State St
Salt Lake City, UT 84111-4535
Phone (801) 328-8543
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109676-2801 | UT | MD | Veterinarian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363824000000",
"number": "1417299074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1220 S STATE ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841114535",
"telephone_number": "801-328-8543",
"fax_number": "801-364-1803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 S STATE ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841114535",
"telephone_number": "801-328-8543",
"fax_number": "801-364-1803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GARY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DVM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-21",
"last_updated": "2013-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "174M00000X",
"taxonomy_group": "",
"desc": "Veterinarian",
"state": "UT",
"license": "109676-2801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Mar 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.