Individual
DR. JAYNE MARIE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1300 N 12TH STREET, SUITE 508, PHOENIX, AZ 85006-2849
(602) 839-3927
(602) 839-4233
Mailing address
1300 N 12TH STREET, SUITE 508, PHOENIX, AZ 85006-2849
(602) 839-3927
(602) 839-4233
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18828
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18828
STATE LICENSE
AZ
05
—
286098
—
AZ
Enumeration date
04/25/2006
Last updated
05/19/2011
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