MEDICARE: ERIC DAVID PETERS MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	27080	AZ

General Provider Information

NPI Number	:	1881200632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DAVID PETERS MD

Provider Business Mailing Address
First Line	:	11545 E QUIET VALLEY PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-8884
Country	:	US
Telephone Number	:	520-471-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	11545 E QUIET VALLEY PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-8884
Country	:	US
Telephone Number	:	520-471-0346
Fax Number	:

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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