Provider Demographics
NPI:1376527945
Name:PETERS, G MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:G MICHAEL
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 E DIXILETA DR UNIT 215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-2274
Mailing Address - Country:US
Mailing Address - Phone:480-361-8082
Mailing Address - Fax:
Practice Address - Street 1:8300 E DIXILETA DR UNIT 215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-2274
Practice Address - Country:US
Practice Address - Phone:480-361-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094467207VG0400X
AZ42743207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ564135Medicaid
NY377821Medicare ID - Type Unspecified
AZZ141797Medicare PIN
C09394Medicare UPIN
AZ564135Medicaid