Provider Demographics
NPI:1225164114
Name:PETERSEN, FINN BO (MD)
Entity Type:Individual
Prefix:DR
First Name:FINN
Middle Name:BO
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:801-408-1819
Mailing Address - Fax:
Practice Address - Street 1:E8 LDS HOSPITAL
Practice Address - Street 2:8TH AVENUE AND C STREET
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-1819
Practice Address - Fax:801-408-3729
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186278-1205207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005697106OtherSELECT HEALTH
UT93796OtherPEHP
UT6620OtherDMBA
UT302931OtherALTIUS
UT302931OtherALTIUS
UT107005697106OtherSELECT HEALTH
UT6620OtherDMBA