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1104365113
DEREK PETERSEN
OGDEN, UT
NPI
1104365113
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: UT 10232646-1206)
Enumeration Date
2017-02-23
Last Update Date
2017-02-23
Business Address
DEREK PETERSEN PA-C
2240 ADAMS AVE
OGDEN, UT 84401-1511
Phone number: 801-393-5355
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Mailing Address
DEREK PETERSEN PA-C
2240 ADAMS AVE
OGDEN, UT 84401-1511
Phone number: 801-393-5355
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