MEDICARE: DR. NICOLAS LEE PETERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0207X	Pediatric Hematology & Oncology Physician	48190	AZ
2	208000000X	Pediatrics Physician	48190	AZ
3	208000000X	Pediatrics Physician	35.094612	OH
4	2080P0207X	Pediatric Hematology & Oncology Physician	35.094612	OH
5	246QM0706X	Medical Technologist
6	208M00000X	Hospitalist Physician	48190	AZ
7	208M00000X	Hospitalist Physician	MD2017-0087	NM
8	208000000X	Pediatrics Physician	MD2017-0087	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487844791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS LEE PETERS M.D.

Provider Business Mailing Address
First Line	:	70 S VAL VISTA DR STE A3-618
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1374
Country	:	US
Telephone Number	:	480-485-5166
Fax Number	:	877-991-6652

Provider Business Practice Location Address
First Line	:	2204 S DOBSON RD STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-6457
Country	:	US
Telephone Number	:	480-485-5166
Fax Number	:	877-991-6652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	06/01/2026

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