Peterson, Mark Gordon
Peterson, Mark Gordon is an individual health care provider with primary practice located at 500 Indiana Ave , Winslow AZ 86047-2169. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Peterson, Mark Gordon can be contacted via phone (928) 289-4646.Contact Information
Primary practice address
500 Indiana Ave
Winslow AZ 86047-2169
Phone: (928) 289-4646
Fax: (928) 289-6229
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 2304 | Alaska |
Profile Details
| NPI number | 1629129168 |
|---|---|
| LBN Legal business name | Peterson, Mark Gordon |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 12th, 2007 |
| Last updated | May 23rd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629129168 | NPPES |
| Alaska | MEDICAID | MD28841 |
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