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General NPI Number Information
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NPI Number | 1427342534
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Entity Type | Organization
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Legal Business Name | MINDBODY MEDICINE PLLC
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 13951 N SCOTTSDALE RD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3452
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Country | US
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Telephone | 480-607-7999
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Fax | 480-607-7998
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Provider Business Mailing Address
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Address Line | 13951 N SCOTTSDALE RD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3452
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Country | US
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Telephone | 480-607-7999
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Fax | 480-607-7998
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Authorized Official
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Title or Position | OWNER, MEDICAL DIRECTOR
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Name | DR. RONALD LEWIS PETERS
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Credential | MD, MPH
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Telephone | 480-607-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 27969
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License Number State | AZ
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