IndividualActive
Jason Petersen, MD
NPI 1215105804 · Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician · Salt Lake City, UT
Provider details
- NPI number
- 1215105804
- Entity type
- Individual
- Primary specialty
- Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 83185641205 (UT)
Specialties & taxonomies
- Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianPrimary2082S0099XLicense 83185641205 (UT)
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
5353 S 960 E
#150
Salt Lake City, UT 84117-3569
Phone: (801) 261-5791
Fax: (801) 747-7740
Approximate (ZIP-level) locationGet directions
Mailing address
5353 S 960 E
Salt Lake City, UT 84117-3569
Registry dates
- Enumerated
- 2008-02-15
- Last updated
- 2012-08-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.