Provider Demographics
NPI:1861648644
Name:PETERSON, AARON JACOB (DO)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JACOB
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4047
Mailing Address - Country:US
Mailing Address - Phone:801-642-2950
Mailing Address - Fax:
Practice Address - Street 1:48 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2910
Practice Address - Country:US
Practice Address - Phone:801-642-2950
Practice Address - Fax:801-642-2951
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3104917-1204207N00000X
AZ005321207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology