Mark R Peterson, DO
Individual provider Active NPI Pediatrics Physician · Hill Afb, UT
NPI 1497067136 · NPPES record last updated May 1, 2018
Key facts
- NPI
- 1497067136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 0102203109 (VA)
- Practice address
- 7321 Balmer St BLDG 570
Hill Afb, UT 84056-5012 - Phone
- (801) 777-5285
- NPI assigned
- Jul 10, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102203109 | VA | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0102203109 | VA | Yes |
Addresses
Primary practice location
7321 Balmer St BLDG 570
Hill Afb, UT 84056-5012
Mailing address
7321 Balmer St BLDG 570
Hill Afb, UT 84056-5012
Phone (801) 777-5285
Other providers in Hill Afb, UT
- Ashley Patterson
- Jason Patterson
- Roger Morris Pedersen
- Gabriel Cecil Pepper
- Justin Scott Peterson
- Julie A Pinchak
- Pamela Sue Reeder
- Stephen Gerard Reinhart
- Wanda Acuna Rivera
- Scott Ross
All providers in Hill Afb, UT · Pediatrics Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.