Provider Demographics
NPI:1972940120
Name:PETERSON, CHRISTOPHER LUKE (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LUKE
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 E SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1719
Mailing Address - Country:US
Mailing Address - Phone:801-814-4351
Mailing Address - Fax:602-839-2232
Practice Address - Street 1:1300 N 12TH ST STE 608
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2850
Practice Address - Country:US
Practice Address - Phone:602-839-4567
Practice Address - Fax:602-839-2232
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60645620207Q00000X
AZ006793207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine