Provider Demographics
NPI:1568410371
Name:PETERS, MARY M (DPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 W CHANDLER HEIGHTS RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5084
Mailing Address - Country:US
Mailing Address - Phone:480-895-0276
Mailing Address - Fax:480-895-6933
Practice Address - Street 1:270 W CHANDLER HEIGHTS RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5084
Practice Address - Country:US
Practice Address - Phone:480-895-0276
Practice Address - Fax:480-895-6933
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0582213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500720Medicaid
AZU96980Medicare UPIN
AZ500720Medicaid
AZZ129893Medicare PIN