Individual
DR. CHARLES SMITH PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3130 E BASELINE RD, SUITE 101, MESA, AZ 85204-7290
(480) 558-3744
(480) 558-3801
Mailing address
8630 E VIA DE VENTURA STE 201, SCOTTSDALE, AZ 85258-3358
(480) 558-3744
(480) 558-3801
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
28027
AZ
Other
Enumeration date
08/10/2005
Last updated
07/30/2019
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