DR. JASON DAYNE PETERSEN (NPI# 1215105804) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215105804 |
| Entity Type | Individual |
| Full Name | DR. JASON DAYNE PETERSEN |
| Credential | MD |
| Practice Address |
5353 S 960 E #150 Salt Lake City UT 84117-3569 |
| Practice Telephone | 8012615791 |
| Practice Fax Number | 8017477740 |
| Mailing Telephone | 8019718684 |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2012-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208200000X | Plastic Surgery | 83185641205 | UT | Allopathic & Osteopathic Physicians |
| Y | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
83185641205 | UT | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407235948 | Jason Petersen | Optometrist | 307 S 1st Ave, Sandpoint, ID 83864-1201 | 2015-05-28 |
| 1194984385 | Jason Mark Petersen | Naturopath | 200 1st Ave W, Ste 405, Seattle, WA 98119-4298 | 2008-06-03 |
| Street Address |
5353 S 960 E #150 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84117-3569 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346597507 | J. Dayne Petersen M.d., PC | Clinic/Center | 5353 S 960 E, #150, Salt Lake City, UT 84117-3569 | 2012-08-07 |
| 1619245529 | Kyungsun Jeong Kim | Pharmacist | 5353 S 960 E, #103, Salt Lake City, UT 84117-3569 | 2011-12-06 |
| 1689957763 | Jessica Blanchard | Pharmacist | 5353 S 960 E, Salt Lake City, UT 84117-3569 | 2011-09-24 |
| 1053693705 | Eric Mckeon | Pharmacist | 5353 S 960 E, Salt Lake City, UT 84117-3569 | 2011-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063052256 | Abundant Dental Care, P.C. | Dentist | 1548 E 4500 S #104, Holladay, UT 84117 | 2020-01-15 |
| 1578127221 | Signature Utah Dental Partners PC | Clinic/Center | 2240 E Murray Holladay Rd, Holladay, UT 84117 | 2019-04-29 |
| 1700392974 | Marette Monson, LLC | Community/Behavioral Health | 2180 East 4500 South, Suite 105, Holladay City, UT 84117 | 2017-12-23 |
| 1942714639 | Harmon City Inc | Pharmacy | 4675 South Holladay Blvd, Holladay, UT 84117 | 2017-11-17 |
| 1881119444 | Brianna Stewart | Physical Medicine & Rehabilitation | 5151 South 900 East, Suite 100, Salt Lake City, UT 84117 | 2017-08-04 |
| 1861842874 | Whitney Aste | Dentist | 1548 E 4500 S Ste 104, Salt Lake City, UT 84117 | 2016-06-21 |
| 1922403765 | Tri-peak, Pllc | Psychologist | 4535 S 2300 E, Suite B, Salt Lake City, UT 84117 | 2014-10-22 |
| 1356689566 | Mckenzie Vierig | Marriage & Family Therapist | 4568 S Highland Dr Ste 380, Millcreek, UT 84117 | 2013-01-22 |
| 1821348640 | Fabiola Marquez Jamieson | Social Worker | 4500 S 2180 E, Suite 165, Holladay, UT 84117 | 2012-09-19 |
| 1073882882 | Amy Rose White | Social Worker | 4500 South 2180 East, Suite 165, Holladay, UT 84117 | 2011-12-22 |
| Find all providers in zip 84117 | ||||
| Taxonomy Code | 2082S0099X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| Specialization | Plastic Surgery Within the Head and Neck |
| A plastic surgeon with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgery is practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. A subspecialty certificate was approved by the ABMS in 2000. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326057258 | University of Utah Plastic Surgery Associates | Plastic Surgery | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003143942 | Robert L. Youngblood, M.d.,p.c. | Plastic Surgery | 880 E 9400 S, Suite 111, Sandy, UT 84094-3667 | 2009-11-13 |
| 1346217882 | Larry A Sargent | Plastic Surgery | 620 Medical Dr, Suite 310, Bountiful, UT 84010-5084 | 2006-03-03 |
| City | SALT LAKE CITY |
| Zip Code | 84117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.