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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