# DALLAS PETERSON MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043526569
- **Authorized official:** GINA MARIE CROWE (ADMINISTRATOR)
- **Authorized official phone:** (928) 537-7011

## Contact information

- **Practice address:** 3401 LOCKWOOD DR, LAKESIDE, AZ 85929-5613
- **Practice address phone:** (928) 368-2060
- **Mailing address:** 1600 S WHITE MOUNTAIN RD, SHOW LOW, AZ 85901-7106
- **Mailing address phone:** (928) 537-7011
- **Mailing address fax:** (928) 251-1063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | AZ23268 | AZ | Yes |

## Other

- **Enumeration date:** 08/21/2010
- **Last updated:** 08/21/2010