Provider Demographics
NPI:1699076224
Name:PETERS, ANGELA YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:YVONNE
Last Name:PETERS
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:UNIVERSITY OF UTAH DEPT OF NEUROLOGY
Mailing Address - Street 2:175 N MEDICAL DRIVE EAST
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-585-6387
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH DEPT OF NEUROLOGY
Practice Address - Street 2:175 N MEDICAL DRIVE EAST
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6049229-12052084N0400X, 2084N0600X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program