Provider Demographics
NPI:1710086624
Name:SEWARD, JOHN PETER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:SEWARD
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-7802
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:10390 N LA CANADA DR STE 110
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-7273
Practice Address - Country:US
Practice Address - Phone:520-420-2110
Practice Address - Fax:520-420-2111
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042722208000000X
CAG28462208000000X
AZ42260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ484301Medicaid
37BBGTSMedicare ID - Type Unspecified