Provider Demographics
NPI:1760506471
Name:CHURGIN, PETER GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GRANT
Last Name:CHURGIN
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 1:1840 E WARNER RD
Mailing Address - Street 2:SUITE A105 - 158
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1840 E WARNER RD
Practice Address - Street 2:SUITE A105 - 158
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3437
Practice Address - Country:US
Practice Address - Phone:480-229-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12239207Q00000X
CAG86275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99274Medicare UPIN