Peterson, Samuel R

Peterson, Samuel R is an individual health care provider with primary practice located at 360 San Miguel Dr Ste 309 , Newport Beach CA 92660-7829. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Peterson, Samuel R can be contacted via phone (949) 640-0434.

Contact Information

Primary practice address
360 San Miguel Dr Ste 309 Newport Beach CA 92660-7829
Phone: (949) 640-0434
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 52631431205 Utah
Allopathic & Osteopathic Physicians / Dermatology 207N00000X C148028 California

Profile Details

NPI number 1073571295
LBN Legal business name Peterson, Samuel R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Jan 19th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073571295 NPPES
Utah Other 107017630101 IHC HEALTHPLANS
Utah Other QM0000066345 IHC HEALTHPLANS
Utah Other P00066498 IHC HEALTHPLANS
Utah Other 03.00174 IHC HEALTHPLANS
Utah Other 72756 IHC HEALTHPLANS
Utah Other 796725 IHC HEALTHPLANS
Utah MEDICAID 870281028000 IHC HEALTHPLANS

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