Provider Demographics
NPI:1982834834
Name:PETERSON, JARED DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DAVID
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1580 W ANTELOPE DR STE 175
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1175
Mailing Address - Country:US
Mailing Address - Phone:801-773-2233
Mailing Address - Fax:017-732-3758
Practice Address - Street 1:1580 W ANTELOPE DR STE 175
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1175
Practice Address - Country:US
Practice Address - Phone:801-773-2233
Practice Address - Fax:385-383-7033
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2024-02-02
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Provider Licenses
StateLicense IDTaxonomies
UT9048627-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology