Shane L Petersen MD

NPI 1770593246 - Anesthesiology - 207L00000X

NPI Details
NPI 1770593246
Gender Male
Enumeration Date 08/08/2006
Last Updated 10/15/2012
Entity Type Individual
Active Over 10 years ago
Practice Location
5121 S COTTONWOOD STREET
INTERMOUNTAIN MEDICAL CENTER
MURRAY UT, 84157, US
Phone (801) 507-5248
Fax (801) 733-5618
Business Location
3340 NORTH CENTER ST #800
LEHI UT, 84043-7406, US
Phone (801) 990-1911
Fax (801) 990-1912
Toxanomy
Taxonomy Code 207L00000X
License State Utah
License Number 2434068-1205
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According to our database, Shane L Petersen MD NPI is 1770593246, taxonomy code is 207L00000X and license number is 2434068-1205, license state is located at Utah. Shane L Petersen MD physically located at 5121 S Cottonwood Street, Murray UT, 84157. NPI Number Shane L Petersen MD has the Individual type.

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1770593246 NPI number is provided on an as is basis without warranty of any kind. 1770593246 is maintained by the National Plan & Provider Enumeration System. The contents of Shane L Petersen MD are for informational purposes only.