Provider Demographics
NPI:1811336241
Name:PETERSON, JUSTIN (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:KY CLINIC GENERAL SURGERY
Mailing Address - Street 2:740 S LIMESTONE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-218-2568
Mailing Address - Fax:859-257-7603
Practice Address - Street 1:BUDGE GENERAL SURGERY
Practice Address - Street 2:1350 N 500 E
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-0001
Practice Address - Country:US
Practice Address - Phone:435-716-1950
Practice Address - Fax:435-716-1950
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2024-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYIP1433208600000X
UT10933355-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery