Provider Demographics
NPI:1588797765
Name:PETE S COURY MD PLLC
Entity Type:Organization
Organization Name:PETE S COURY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-654-6400
Mailing Address - Street 1:5424 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3621
Mailing Address - Country:US
Mailing Address - Phone:480-654-6200
Mailing Address - Fax:480-654-6214
Practice Address - Street 1:5424 E SOUTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3621
Practice Address - Country:US
Practice Address - Phone:480-654-6200
Practice Address - Fax:480-654-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z83970Medicare Oscar/Certification
Z83970Medicare PIN
AZH11277Medicare UPIN