MEDICARE: MR. PETER TRETHEWEY P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2138	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z75233	OTHER	AZ	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700987104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER TRETHEWEY P.A.-C

Provider Business Mailing Address
First Line	:	1250 S CLEARVIEW AVE
Second Line	:	SUITE 100
City	:	MESA
State	:	AZ
Zip	:	85209-3378
Country	:	US
Telephone Number	:	480-988-9108
Fax Number	:	480-813-4460

Provider Business Practice Location Address
First Line	:	4232 W BELL RD
Second Line	:	SUITE C1
City	:	GLENDALE
State	:	AZ
Zip	:	85308-4027
Country	:	US
Telephone Number	:	602-639-4535
Fax Number	:	602-942-4717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/06/2014

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