Individual
DR. MARK DAVID PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2632 N 20TH ST, PHOENIX, AZ 85006-1339
(602) 266-2200
(602) 240-6177
Mailing address
PO BOX 61773, PHOENIX, AZ 85082-1773
(602) 682-6701
(602) 240-6177
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35706
AZ
2086S0129X
Vascular Surgery Physician
35706
AZ
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
321958
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147570
—
AZ
01
—
35706
AZ LICENSE #
AZ
01
—
CPSO 72684
ONTARIO MEDICAL LICENSE
AZ
01
—
WCSKQ
SUN HEALTH GROUP #
AZ
Enumeration date
09/24/2006
Last updated
09/18/2023
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