SAMUEL R PETERSON (NPI# 1073571295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073571295 |
| Entity Type | Individual |
| Full Name | SAMUEL R PETERSON |
| Credential | MD |
| Practice Address |
1055 N 500 W Provo UT 84604-3305 |
| Practice Telephone | 8013748999 |
| Practice Fax Number | 8014298063 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014298180 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-11-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 52631431205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | UNITED HEALTHCARE | 03.00174 | 01 |
| UT | DMBA | 796725 | 01 |
| UT | PALMETTO GBA | P00066498 | 01 |
| UT | 870281028000 | 05 | |
| UT | IHC HEALTHPLANS | 107017630101 | 01 |
| UT | PEHP | 72756 | 01 |
| UT | ALTIUS | QM0000066345 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013547306 | Samuel Peterson | Counselor | 4600 Debarr Rd, Anchorage, AK 99508-3103 | 2020-01-25 |
| 1780218149 | Samuel Peterson | Pharmacist | 2625 W National Ave, Milwaukee, WI 53204-1068 | 2020-02-25 |
| 1376090118 | Samuel Peterson | Occupational Therapist | 3350 La Jolla Village Dr, San Diego, CA 92161-0002 | 2016-09-09 |
| 1699192732 | Samuel Peterson | Dentist | 1830 E Innovation Park Dr, Oro Valley, AZ 85755 | 2014-03-26 |
| 1720332968 | Samuel Nolan Peterson | Audiologist | 1867 Williams Hwy, Ste. 105, Grants Pass, OR 97527-5854 | 2012-11-08 |
| Street Address |
1055 N 500 W |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144223835 | Bruce C Mcallister | Specialist | 1055 N 500 W, Suite 102, Provo, UT 84604-3305 | 2005-05-27 |
| 1922641448 | Lilian Silva Dana | Nurse Practitioner | 1055 N 500 W, Suite. 222, Bldg. C, Provo, UT 84604 | 2019-10-28 |
| 1407373574 | Kristie Christensen | Nurse Practitioner | 1055 N 500 W, Ste 101, Bldg C, Provo, UT 84604-3305 | 2017-08-29 |
| 1942664867 | Holly Ann Bishop Michaels | Dietitian, Registered | 1055 N 500 W, Attn. Credentialing, Provo, UT 84604-3305 | 2016-04-06 |
| 1841650967 | Maile Yuzon | Physician Assistant | 1055 N 500 W, Ste 212, Provo, UT 84604-3305 | 2016-03-02 |
| 1497127658 | Kayla Hamrick Lussier | Nurse Practitioner | 1055 N 500 W, Suite 212, Provo, UT 84604-3305 | 2015-10-28 |
| 1962873281 | Ryan Francis | Nurse Practitioner | 1055 N 500 W, Ste 121, Provo, UT 84604-3305 | 2015-10-13 |
| 1083082283 | Leslee Ronald Adams | Registered Nurse | 1055 N 500 W, Ste 211, Provo, UT 84604-3305 | 2015-09-04 |
| 1750763629 | Cydne Suzannah Baird Evans | Physician Assistant | 1055 N 500 W, Ste 100, Provo, UT 84604-3305 | 2015-06-26 |
| 1073903720 | Rosanne Johnson Oliver | Nurse Practitioner | 1055 N 500 W, Ste 205, Provo, UT 84604-3305 | 2015-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770099251 | Ihc Health Services Inc | Dermatology | 395 W Bulldog Blvd Ste 604, Provo, UT 84604-3331 | 2017-12-20 |
| 1558658237 | Garrett C Lowe | Dermatology | 3200 N Canyon Rd Ste D, Provo, UT 84604-4678 | 2011-07-01 |
| 1407943921 | Payam Tristani-firouzi | Dermatology | 1055 N 500 W Ste 111, Provo, UT 84604-3305 | 2006-10-06 |
| 1548262801 | Richard L Stone | Dermatology | 1275 N University Ave Ste 23, Provo, UT 84604-7125 | 2005-06-01 |
| 1639490386 | Kevin Hall Gardner | Dermatology | 1055 N 500 W, Ste 111, Provo, UT 84604-3305 | 2010-06-17 |
| 1982662102 | Mark L Donaldson | Dermatology | 1055 N 500 W, Suite 111, Provo, UT 84604-3305 | 2006-05-04 |
| 1811955800 | Brian R Bradshaw | Dermatology | 1055 N 500 W, Suite 111, Provo, UT 84604-3305 | 2006-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245863893 | Central Utah Dermatology | Dermatology | 861 N Main, Richfield, UT 84701 | 2020-02-21 |
| 1548810401 | Smart & Gibbs | Dermatology | 3200 W Clubhouse Dr Ste 100, Lehi, UT 84043-4325 | 2019-09-12 |
| 1043874332 | Waymore Shade LLC | Dermatology | 451 S Main St Ste 1, Springville, UT 84663-2293 | 2019-04-23 |
| 1598261869 | Tuttle Dermatology PC | Dermatology | 617 E Riverside Dr Ste 103, St George, UT 84790-8049 | 2018-04-04 |
| 1417467986 | Red Ledges Dermatology Pllc | Dermatology | 1449 N 1400 W Ste 22, St George, UT 84770-5237 | 2017-10-10 |
| 1649724139 | University of Utah Adult Services | Dermatology | 165 N. University Ave. Farmington, Farmington, UT 84025 | 2016-08-12 |
| 1861861155 | Brent H. Goodsell, Do | Dermatology | 162 S 1100 E, American Fork, UT 84003-2817 | 2015-09-17 |
| 1912316654 | Jeanna Tachiki Ryan | Dermatology | 243 E 6100 S, Murray, UT 84107-7302 | 2014-08-07 |
| 1659785889 | Dana Rice | Dermatology | 6095 S Fashion Blvd Ste 270, Murray, UT 84107-7387 | 2014-06-16 |
| 1548680184 | West Valley Dermatology | Dermatology | 3465 S Pioneer Pkwy, Suite 1, Salt Lake City, UT 84120-2076 | 2014-04-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.