# TUCKER BAG LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nathan Petersen, M.D.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336596345
- **Authorized official:** NATHAN JEFFREY PETERSEN M.D. (MEMBER)
- **Authorized official phone:** (623) 414-3500

## Contact information

- **Practice address:** 6370 W. UNION HILLS DR., GLENDALE, AZ 85308
- **Practice address phone:** (623) 414-3500
- **Practice address fax:** (623) 374-2549
- **Mailing address:** 6370 W. UNION HILLS DR., GLENDALE, AZ 85308
- **Mailing address phone:** (623) 414-3500
- **Mailing address fax:** (623) 374-2549

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 51043 | AZ | Yes |

## Other

- **Enumeration date:** 05/19/2016
- **Last updated:** 05/19/2016