IndividualActive
Andrew Petersen, DO
NPI 1124011572 · Family Medicine Physician · Provo, UT
Provider details
- NPI number
- 1124011572
- Entity type
- Individual
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- License
- M4441 (TX)
Practice location
524 W 300 N Ste 203
Provo, UT 84601-2669
Phone: (801) 607-5268
Fax: (801) 607-5271
Mailing address
524 W 300 N Ste 203
Provo, UT 84601-2669
Registry dates
- Enumerated
- 2005-08-31
- Last updated
- 2014-05-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.