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General NPI Number Information
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NPI Number | 1609207075
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Entity Type | Organization
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Legal Business Name | YOUR HEALTH HOME PLLC
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 2035 MESQUITE AVE SUITE C
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5894
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Country | US
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Telephone | 928-680-3343
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Fax | 928-680-3342
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Provider Business Mailing Address
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Address Line | PO BOX 1969
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-1969
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Country | US
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Telephone | 928-680-3343
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Fax | 928-680-3342
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. ROBERT D PETERSON
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Credential | M.D.
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Telephone | 928-680-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 48485
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License Number State | AZ
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