Provider Demographics
NPI:1700850351
Name:MESA UROLOGISTS PC
Entity Type:Organization
Organization Name:MESA UROLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-985-8478
Mailing Address - Street 1:6553 E BAYWOOD AVE
Mailing Address - Street 2:#209
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1752
Mailing Address - Country:US
Mailing Address - Phone:480-985-8478
Mailing Address - Fax:480-985-0175
Practice Address - Street 1:6553 E BAYWOOD AVE
Practice Address - Street 2:#209
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1752
Practice Address - Country:US
Practice Address - Phone:480-985-8478
Practice Address - Fax:480-985-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1184625832OtherNPI
AZ1730180431OtherNPI
AZ1902807514OtherNPI