NPIMap

Organization Active NPI

Robert G Peterson, MD, PC

  • Neurological Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1629249495
Registry record updated Mar 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
180034-1205 Issued in UT
Legal business name
ROBERT G PETERSON, MD, PC
Practice address
370 Ninth Ave
Ste 111
Salt Lake City, UT 84103-2877
Phone
(801) 408-2233
Fax
(801) 408-2870
NPI assigned
Mar 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2008

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

Authorized official

Name
Robert G Peterson, MD
Title
President of Corporation
Phone
(801) 408-2233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X 180034-1205 UT Primary

Addresses

Primary practice location

370 Ninth Ave
Ste 111
Salt Lake City, UT 84103-2877

Mailing address

370 Ninth Ave
Ste 111
Salt Lake City, UT 84103-2877
Phone (801) 408-2233

Other identifiers 1

IdentifierTypeStateIssuer
528801589001MedicaidUT

National Provider Directory

National Provider Directory

Locations

370 Ninth Ave
#111
Slc, UT 84103
Phone (801) 408-2067

Practitioners & affiliated clinicians

Practitioners 4

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": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1629249495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 NINTH AVE",
            "address_2": "STE 111",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841032877",
            "telephone_number": "801-408-2233",
            "fax_number": "801-408-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 NINTH AVE",
            "address_2": "STE 111",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841032877",
            "telephone_number": "801-408-2233",
            "fax_number": "801-408-2870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT G PETERSON, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "801-408-2233",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "UT",
            "license": "180034-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528801589001",
            "state": "UT"
        }
    ],
    "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 19, 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.