Red Ledges Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

179077-1204 Issued in UT

Legal business name

RED LEDGES DERMATOLOGY PLLC

Practice address

1449 N 1400 W Ste 22
St George, UT 84770-5237

Phone

(435) 703-9296

NPI assigned

Oct 10, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Warren Albert Petererson, DO

Title

Owner

Phone

(435) 703-9296

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520467200000",
    "number": "1417467986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1449 N 1400 W STE 22",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847705237",
            "telephone_number": "435-703-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 N 1400 W STE 22",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847705237",
            "telephone_number": "435-703-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED LEDGES DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2018-03-08",
        "status": "A",
        "authorized_official_last_name": "PETERERSON",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-703-9296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "UT",
            "license": "179077-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in St George, UT
• Providers in St George, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.