Provider Demographics
NPI:1316998560
Name:CENTER FOR ADVANCED PLASTIC SURGERY
Entity type:Organization
Organization Name:CENTER FOR ADVANCED PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:435-628-2895
Mailing Address - Street 1:676 S BLUFF ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3596
Mailing Address - Country:US
Mailing Address - Phone:435-628-2895
Mailing Address - Fax:435-628-5943
Practice Address - Street 1:676 S BLUFF ST
Practice Address - Street 2:SUITE 207
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3596
Practice Address - Country:US
Practice Address - Phone:435-628-2895
Practice Address - Fax:435-628-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT101009187101OtherIHC RHODES
UT107007770102OtherIHC PET
UT19344612000001OtherVALUECARE
NV2085401OtherBCBS NV
UT0007137728OtherAETNA
UT19344612000001OtherREGENCE
UT902568OtherDMBA
KY0004328723OtherAETNA
UT101009187101OtherIHC RHODES
NV2085401OtherBCBS NV
UT902568OtherDMBA
UT========= B58557OtherBC FED
UT0007137728OtherAETNA
UT========= B58557OtherBC FED