Healthcare Provider Details

I. General information

NPI: 1700882651
Provider Name (Legal Business Name): BRENDA C PEART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6567 E CARONDELET DR SUITE 225
TUCSON AZ
85710-6152
US

IV. Provider business mailing address

3501 E SPEEDWAY BLVD STE 300
TUCSON AZ
85716-3928
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-3432
  • Fax: 520-886-0169
Mailing address:
  • Phone: 520-886-3432
  • Fax: 520-886-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16682
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16682
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number16682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: