Organization
YOUR HEALTH HOME PLLC
Active
Organization
YOUR HEALTH HOME PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT D PETERSON M.D. (OWNER/MEMBER)
(928) 680-3343
Entity
Organization
Contact information
Practice address
2035 MESQUITE AVE, SUITE C, LAKE HAVASU CITY, AZ 86403-5894
(928) 680-3343
(928) 680-3342
Mailing address
PO BOX 1969, LAKE HAVASU CITY, AZ 86405-1969
(928) 680-3343
(928) 680-3342
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
48485
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
885211
—
AZ
01
—
P-18894563
PLLC REGISTRATION NUMBER
AZ
Enumeration date
12/10/2013
Last updated
03/13/2014
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