Provider Demographics
NPI:1265244800
Name:BIDON, PETER MICHAEL (FNP)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:BIDON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 W IVEY RD
Mailing Address - Street 2:
Mailing Address - City:HUACHUCA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85616-8280
Mailing Address - Country:US
Mailing Address - Phone:520-249-5075
Mailing Address - Fax:
Practice Address - Street 1:399 W IVEY RD
Practice Address - Street 2:
Practice Address - City:HUACHUCA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85616-8280
Practice Address - Country:US
Practice Address - Phone:520-249-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care