Individual
DR. MARK GORDON PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
(928) 289-6229
Mailing address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
(928) 289-6229
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2304
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD28841
—
AK
Enumeration date
01/12/2007
Last updated
05/23/2014
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