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General NPI Number Information
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NPI Number | 1912906645
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH PETERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 167 NORTH MAIN STREET
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City | TUBA CITY
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State | AZ
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Zip | 86045-0600
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Country | US
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Telephone | 928-283-2501
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Fax | 928-283-2677
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Provider Business Mailing Address
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Address Line | P.O. BOX 600
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City | TUBA CITY
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State | AZ
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Zip | 86045-0600
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Country | US
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Telephone | 928-283-2501
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Fax | 928-283-2677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 9582
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License Number State | AZ
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