Individual
STEPHEN LYNN PETERSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1350 S ELLSWORTH RD APT 1122, MESA, AZ 85209-2809
(480) 326-8100
Mailing address
1350 S ELLSWORTH RD APT 1122, MESA, AZ 85209-2809
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
005988
AZ
332B00000X
Durable Medical Equipment & Medical Supplies
1945208
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480036
AHCCCS
AZ
Enumeration date
01/13/2019
Last updated
09/20/2019
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