Peterson, Mark David
Peterson, Mark David is an individual health care provider with primary practice located at 2632 N 20Th St , Phoenix AZ 85006-1339. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery). Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) is his primary health care specialty. Peterson, Mark David can be contacted via phone (602) 266-2200.Contact Information
Primary practice address
2632 N 20Th St
Phoenix AZ 85006-1339
Phone: (602) 266-2200
Fax: (602) 240-6177
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 35706 | Arizona |
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | 35706 | Arizona |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 321958 | New York |
Profile Details
| NPI number | 1326148800 |
|---|---|
| LBN Legal business name | Peterson, Mark David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 24th, 2006 |
| Last updated | Sep 18th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326148800 | NPPES |
| Arizona | MEDICAID | 147570 | |
| Arizona | Other | WCSKQ | |
| Arizona | Other | 35706 | |
| Arizona | Other | CPSO 72684 |
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