DR. MARK DAVID PETERSON (NPI# 1326148800) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326148800 |
| Entity Type | Individual |
| Full Name | DR. MARK DAVID PETERSON |
| Credential | MD |
| Practice Address |
2632 N 20th St Phoenix AZ 85006-1339 |
| Mailing Address |
Po Box 61773 Phoenix AZ 85082-1773 |
| Practice Telephone | 6022662200 |
| Practice Fax Number | 6022406177 |
| Mailing Telephone | 6026826701 |
| Mailing Fax Number | 6022406177 |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-11-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 35706 | AZ | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
35706 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 147570 | 05 | |
| AZ | AZ LICENSE # | 35706 | 01 |
| AZ | SUN HEALTH GROUP # | WCSKQ | 01 |
| AZ | ONTARIO MEDICAL LICENSE | CPSO 72684 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164069696 | Mark Alan Peterson | In Home Supportive Care | 5870 Nw 54th Ct, Johnston, IA 50131-1418 | 2019-12-03 |
| 1841474012 | Mark Frederic Peterson I | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3351 36th St, Grand Rapids, MI 49331 | 2007-12-24 |
| 1780877258 | Mark A. Peterson | Counselor | 7322 Scenic Oaks Cir, Austin, TX 78745-5217 | 2007-08-19 |
| 1871702076 | Mark Clayton Peterson | Dentist | 1600 W Sunset Rd Ste B, Henderson, NV 89014-2655 | 2007-05-22 |
| 1558481366 | Mark Theodore Peterson | Specialist | 5712 Newburg Rd, Rockford, IL 61108-6707 | 2007-03-29 |
| 1073608170 | Mark A Peterson | Dentist | 7740 Bay St, Suite # 1, Sebastian, FL 32958-3427 | 2006-10-04 |
| 1689782864 | Mark L Peterson | Dentist | 127 1/2 E Short St, Rigby, ID 83442-1422 | 2006-08-28 |
| 1528013661 | Mark Edward Peterson | Dentist | 2440 Gaynor Nw, Grand Rapids, MI 49544-1830 | 2006-05-24 |
| 1699763607 | Mark Delano Peterson | Orthopaedic Surgery | 1311 E Barnett Rd, Ste 201, Medford, OR 97504-8225 | 2005-10-12 |
| 1477551836 | Mark Dean Peterson | Chiropractor | 5406 Alderson St, Schofield, WI 54476-2264 | 2005-07-11 |
| Street Address |
2632 N 20TH ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85006-1339 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215938147 | Rajagopalan Ravi | Surgery | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2005-08-02 |
| 1083043210 | Joei Johns | Physician Assistant | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2013-11-07 |
| 1659685782 | Vhs Arizona Heart Institute Inc | Internal Medicine | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2010-07-30 |
| 1093966194 | Hussein Dawod Jabr | Specialist/Technologist, Other | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2008-10-07 |
| 1457508723 | Ahi Cardiovascular Surgeons Ltd | Internal Medicine | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2008-08-19 |
| 1144482886 | Ahi Cardiovascular Surgeons Ltd | Radiology | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2008-06-25 |
| 1952423311 | Michael Ipo Chow | Surgery | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2007-04-05 |
| 1316067549 | Carole Jane Klein | Counselor | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2007-03-30 |
| 1972648087 | Arizona Heart Institute Ltd | Specialist | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2007-02-20 |
| 1194879296 | Arizona Heart Institute Ltd | Clinic/Center | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2007-01-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356949929 | Teresa Louise Cox | Pharmacist | 1800 E Van Buren St., St. Luke's Behavioral Health, Phoenix, AZ 85006 | 2020-10-15 |
| 1558985036 | Amanda Stanford | Nurse Practitioner | 925 E Mc Dowell Rd, Phoenix, AZ 85006 | 2020-06-01 |
| 1023638582 | Supraja Prakash | Genetic Counselor, MS | 1920 E Cambridge Ave., Rosenberg Bldg., Suite 304, Phoenix, AZ 85006 | 2020-04-24 |
| 1760017099 | Phoenix Medical Psychiatric Hospital, LLC | Psychiatric Hospital | 1346 Mcdowell Road, Phoenix, AZ 85006 | 2020-03-06 |
| 1265093108 | Zulianna Ibrahim | Student in an Organized Health Care Education/Training Program | Banner University Medical Center Phoenix Family Medicin, 1300 N. 12th Street Suite 605, Phoenix, AZ 85006 | 2019-06-21 |
| 1306318340 | Leah Margaret Hillier | Family Medicine | 1300 N 12th St - Suite 500, Phoenix, AZ 85006 | 2018-12-31 |
| 1477032357 | Joann Moskop | Chiropractor | 2719 N Greenfield Rd., Phoenix, AZ 85006 | 2018-08-10 |
| 1619464468 | Ana Maria Lara | Naturopath | 926 E Mcdowell Rd Ste 204, Phoenix, AZ 85006 | 2018-04-17 |
| 1194221770 | Nisha Bharat Patel | Student in an Organized Health Care Education/Training Program | Edwards Medical Plaza Suite 320, 1300 North 12th Street, Phoenix, AZ 85006 | 2018-04-03 |
| 1710486352 | Julia Cyr | Registered Nurse | 1008 E Mcdowell Rd Unit A, Phoenix, AZ 85006 | 2018-02-09 |
| Find all providers in zip 85006 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144746033 | Az Surgical Solutions | Surgery | 3724 N 3rd St Ste 302, Phoenix, AZ 85012-2034 | 2017-08-22 |
| 1184072894 | Eugene L De La Cruz Dpm PC | Surgery | 1743 W Sienna Bouquet Pl, Phoenix, AZ 85085-8040 | 2016-06-03 |
| 1164821112 | Arizona Surgical Associates, Plc | Surgery | 9305 W Thomas Rd Ste 480, Phoenix, AZ 85037-3375 | 2014-08-15 |
| 1639443096 | Joseph Patrick Kennelly | Surgery | 5941 E Lafayette Blvd, Phoenix, AZ 85018-4660 | 2012-03-02 |
| 1285927574 | Para Surgical Specialists, Pllc | Surgery | 9515 W. Camelback Rd, Suite 132, Phoenix, AZ 85037-0000 | 2011-05-19 |
| 1427347665 | Morley Rosenfield | Surgery | 3039 E Marshall Ave, Phoenix, AZ 85016-3713 | 2011-03-28 |
| 1962705889 | Richard Lance Chilian | Surgery | 2539 West Bloch Road, Phoenix, AZ 85041-2908 | 2010-12-15 |
| 1205140027 | Tracy Lynn Freeborn | Surgery | 9250 W Thomas Rd Ste 250, Phoenix, AZ 85037 | 2010-08-04 |
| 1407176126 | Martin E. Zipser | Surgery | 7320 N Dreamy Draw Dr, Phoenix, AZ 85020-5212 | 2010-06-03 |
| 1649413089 | Kaavya Reddy Matatova | Surgery | 19646 N 27th Ave Ste 201, Phoenix, AZ 85027-4026 | 2009-04-15 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.