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Contact Information

BRIAN R PETERSON, MD
3584 W 9000 S
SUITE 311
WEST JORDAN, UT84088-5710
 Phone: 801-566-8304
 Fax: 801-566-8304
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otology & Neurotology

207YX0901X 04 Physician/Otolaryngology
 

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for BRIAN R PETERSON · (Male)

NPI # 1316978687
Status Active
Credentials MD
Entity Individual
Enumeration date 07/05/2006
Last updated 11/02/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 036142390
  • UT License # 313974-1205
  • IL Other 214881 MEDICARE GROUP PTAN
Hospital affiliation(s)
  • MEMORIAL HOSPITAL OF CARBONDALE - (Acute Care)
    405 W JACKSON
    CARBONDALE, IL 62902
  • ST JOSEPH MEMORIAL HOSPITAL - (Critical Access)
    2 SOUTH HOSPITAL DRIVE
    MURPHYSBORO, IL 62966
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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