Provider Demographics
NPI:1184625832
Name:MATTHEWS, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:MATTHEWS
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 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4135 S POWER RD
Practice Address - Street 2:#120
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3626
Practice Address - Country:US
Practice Address - Phone:480-985-8478
Practice Address - Fax:480-985-0175
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18945208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288630Medicaid
AZZ144627Medicare PIN