Individual
MARK STEVEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Mailing address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
23713
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
23713
AZ
2085U0001X
Diagnostic Ultrasound Physician
23713
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005472
GROUP MEDICAID ID
AZ
01
—
1588635544
PHYSICIAN INDIVIDUAL NPI
AZ
01
—
1841261989
GROUP NPI
AZ
01
—
300129081
MEDICARE RAILROAD
AZ
05
—
645369
—
AZ
01
—
CS7943
GROUP MEDICARE RAILROAD ID & PTAN
AZ
01
—
ZWCBBM
GROUP MEDICARE ID
AZ
Enumeration date
01/30/2006
Last updated
02/27/2013
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