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Organization
TUCKER BAG LLC
Active
Organization
TUCKER BAG LLC
Active
Other names
Nathan Petersen, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN JEFFREY PETERSEN M.D. (MEMBER)
(623) 414-3500
Entity
Organization
Contact information
Practice address
6370 W. UNION HILLS DR., GLENDALE, AZ 85308
(623) 414-3500
(623) 374-2549
Mailing address
6370 W. UNION HILLS DR., GLENDALE, AZ 85308
(623) 414-3500
(623) 374-2549
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
51043
AZ
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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