Provider Demographics
NPI:1740283423
Name:LEOPOLD, PETER (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LEOPOLD
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 1:3333 E CAMELBACK RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2322
Mailing Address - Country:US
Mailing Address - Phone:602-997-0484
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:2580 HIGHWAY 95 STE 224
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7332
Practice Address - Country:US
Practice Address - Phone:928-704-7011
Practice Address - Fax:928-704-7014
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3500207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642159Medicaid
AZ642159Medicaid
NVVWCGWMMedicare PIN
AZ112319Medicare PIN
AZ114933Medicare PIN
AZ67660Medicare PIN
AZ123755Medicare PIN