Healthcare Provider Details

I. General information

NPI: 1104054311
Provider Name (Legal Business Name): ANUJ PETER NETTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 300
PHOENIX AZ
85016-4879
US

IV. Provider business mailing address

61 WHITCHER ST NE SUITE 1100
MARIETTA GA
30060-1176
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-6211
  • Fax: 866-846-8709
Mailing address:
  • Phone: 770-422-3290
  • Fax: 770-422-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA131563
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number073874
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number58654
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: