Provider Demographics
NPI:1912406919
Name:PETERSON, CELESTE KNIGHT (MD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:KNIGHT
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 S WATERBURY WAY STE B102
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6209
Mailing Address - Country:US
Mailing Address - Phone:801-274-2000
Mailing Address - Fax:801-274-2020
Practice Address - Street 1:1160 E 3900 S STE 1200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1251
Practice Address - Country:US
Practice Address - Phone:801-365-0909
Practice Address - Fax:801-261-9656
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11917518-1205207R00000X
MT9965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine