Provider Demographics
NPI:1568439966
Name:FERRARA, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:FERRARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3604 N WELLS FARGO AVENUE
Mailing Address - Street 2:SUITE L
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5629
Mailing Address - Country:US
Mailing Address - Phone:480-947-7401
Mailing Address - Fax:480-946-5565
Practice Address - Street 1:3604 N WELLS FARGO AVENUE
Practice Address - Street 2:SUITE L
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5629
Practice Address - Country:US
Practice Address - Phone:480-947-7401
Practice Address - Fax:480-946-5565
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ20000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ052267OtherAHCCCS
E84549Medicare UPIN
AZZ64583Medicare PIN