Provider Demographics
NPI:1972026896
Name:OBEN, PETER EBOT (RVT, RDCS,RDMA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EBOT
Last Name:OBEN
Suffix:
Gender:M
Credentials:RVT, RDCS,RDMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 E MAIN ST STE 123
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8928
Mailing Address - Country:US
Mailing Address - Phone:678-857-0705
Mailing Address - Fax:
Practice Address - Street 1:6040 E MAIN ST STE 123
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8928
Practice Address - Country:US
Practice Address - Phone:678-857-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ702712085U0001X, 2471S1302X, 2471V0105X, 246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography