Healthcare Provider Details

I. General information

NPI: 1609872894
Provider Name (Legal Business Name): PETER C KAISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E. BELL ROAD SUITE 5800
PHOENIX AZ
85032-2190
US

IV. Provider business mailing address

3805 E. BELL ROAD SUITE 5800
PHOENIX AZ
85032-2190
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-6500
  • Fax: 602-867-3144
Mailing address:
  • Phone: 602-688-6500
  • Fax: 602-867-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number22523
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22523
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: