Provider Demographics
NPI:1609872894
Name:KAISER, PETER C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:KAISER
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 1:3805 E. BELL ROAD
Mailing Address - Street 2:SUITE 5800
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2190
Mailing Address - Country:US
Mailing Address - Phone:602-688-6500
Mailing Address - Fax:602-867-3144
Practice Address - Street 1:3805 E. BELL ROAD
Practice Address - Street 2:SUITE 5800
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2190
Practice Address - Country:US
Practice Address - Phone:602-688-6500
Practice Address - Fax:602-867-3144
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22523174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWMBCQ03OtherMEDICARE
AZF51438Medicare UPIN