Provider Demographics
NPI:1700987104
Name:TRETHEWEY, PETER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:TRETHEWEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S CLEARVIEW AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3378
Mailing Address - Country:US
Mailing Address - Phone:480-988-9108
Mailing Address - Fax:480-813-4460
Practice Address - Street 1:4232 W BELL RD
Practice Address - Street 2:SUITE C1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4027
Practice Address - Country:US
Practice Address - Phone:602-639-4535
Practice Address - Fax:602-942-4717
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75233OtherMEDICARE PTAN
AZ921793Medicaid
AZP91141Medicare UPIN