Healthcare Provider Details

I. General information

NPI: 1225075005
Provider Name (Legal Business Name): PETER JOHN STEVENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E WILLETTA ST ROOM 3503
PHOENIX AZ
85006-2727
US

IV. Provider business mailing address

9337 E DALE LN
SCOTTSDALE AZ
85262-2334
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-5166
  • Fax:
Mailing address:
  • Phone: 480-361-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number31598
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: