Provider Demographics
NPI:1073552519
Name:NIELSEN, PETER CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHRISTIAN
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-8399
Mailing Address - Fax:801-408-5152
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-8399
Practice Address - Fax:801-408-5152
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49722151205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1689709859Medicaid
UT1689709859Medicaid
UT005516903Medicare PIN
UTA48295Medicare UPIN