Individual
DR. KEVIN JEROME PEINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6644 E BAYWOOD AVE, BANNER BAYWOOD MEDICAL CENTER, MESA, AZ 85206
(480) 321-3900
(480) 321-3840
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
46381
AZ
207R00000X
Internal Medicine Physician
Primary
MD2017-0635
NM
208M00000X
Hospitalist Physician
46381
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34150757
—
NM
05
—
721556
—
AZ
Enumeration date
01/25/2012
Last updated
04/16/2019
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