Healthcare Provider Details

I. General information

NPI: 1780654970
Provider Name (Legal Business Name): BRIAN DREW PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7287 E. EARLL DRIVE BUILDING D
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

25000 N. NORTERRA PARKWAY BUILDING B
PHOENIX AZ
85085
US

V. Phone/Fax

Practice location:
  • Phone: 480-840-0800
  • Fax:
Mailing address:
  • Phone: 623-277-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13489
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: