Healthcare Provider Details

I. General information

NPI: 1164548814
Provider Name (Legal Business Name): PETER M PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E THOMPSON PEAK PKWY
SCOTTSDALE AZ
85255-4109
US

IV. Provider business mailing address

9225 N 3RD ST STE 300
PHOENIX AZ
85020-2466
US

V. Phone/Fax

Practice location:
  • Phone: 602-445-0751
  • Fax: 602-424-8128
Mailing address:
  • Phone: 602-445-0751
  • Fax: 602-424-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36657
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number36657
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: