Individual provider · Type 1 NPI

Derek Petersen, PA-C

Physician Assistant · Ogden, UT

NPI number 1104365113 Active

Practice location

2240 Adams Ave
Ogden, UT 84401-1511

Call (801) 393-5355 Map

Other practice locations

  • 5285 S 400 E Ste A, Washington Terrace, UT 84405-7194 · (801) 334-0048

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X10232646-1206 (UT)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1104365113

Derek Petersen, PA-C's National Provider Identifier is 1104365113, issued on Feb 23, 2017. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Ogden, UT. The record was last updated on Feb 3, 2026.