Healthcare Provider Details

I. General information

NPI: 1376527945
Provider Name (Legal Business Name): G MICHAEL PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 E DIXILETA DR UNIT 215
SCOTTSDALE AZ
85266-2274
US

IV. Provider business mailing address

8300 E DIXILETA DR UNIT 215
SCOTTSDALE AZ
85266-2274
US

V. Phone/Fax

Practice location:
  • Phone: 480-361-8082
  • Fax:
Mailing address:
  • Phone: 480-361-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number094467
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number42743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: