Provider Demographics
NPI:1932249612
Name:SANTOS, PETER W (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:SANTOS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3333 E CAMELBACK RD
Mailing Address - Street 2:STE 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 1:18699 N 67TH AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7140
Practice Address - Country:US
Practice Address - Phone:623-240-4277
Practice Address - Fax:623-566-0263
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4614207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ207715Medicaid
AZ207715Medicaid