Individual
NATHAN JEFFREY PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6370 W UNION HILLS DR, GLENDALE, AZ 85308-7136
(623) 414-3500
(623) 455-9214
Mailing address
6370 W UNION HILLS DR, GLENDALE, AZ 85308-7136
(623) 414-3500
(623) 455-9214
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
51043
AZ
207V00000X
Obstetrics & Gynecology Physician
R72843
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167288
—
AZ
Enumeration date
06/10/2011
Last updated
11/02/2017
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