Individual
DR. SCOTT RICHARD PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W THOMAS RD, SUITE 400, PHOENIX, AZ 85013-4224
(602) 406-3157
(602) 406-4113
Mailing address
FILE 56765, LOS ANGELES, CA 90074-6765
(602) 406-3860
(602) 406-6132
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
14414
AZ
2086S0102X
Surgical Critical Care Physician
14414
AZ
2086S0127X
Trauma Surgery Physician
Primary
14414
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231720
—
AZ
Enumeration date
01/12/2006
Last updated
07/19/2012
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