Provider Demographics
NPI:1598751497
Name:COURY, PETE S (MD)
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:S
Last Name:COURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z83970OtherPTAN
AZPOO161560OtherRAILROAD MEDICARE
AZAZ0763830OtherBLUE CROSS BLUE SHIELD
AZAZ0763830OtherBLUE CROSS BLUE SHIELD
Z83970OtherPTAN
Z83970Medicare UPIN
AZZ83970Medicare Oscar/Certification