| Dallas Peterson Md Pllc | |
|
3401 Lockwood Dr Lakeside AZ 85929-5613 | |
| (928) 368-2060 | |
| Not Available |
| Full Name | Dallas Peterson Md Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 3401 Lockwood Dr, Lakeside, Arizona |
| Authorized Official Name and Position | Gina Marie Crowe (ADMINISTRATOR) |
| Authorized Official Contact | 9285377011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dallas Peterson Md Pllc 1600 S White Mountain Rd Show Low AZ 85901-7106 Ph: (928) 537-7011 | Dallas Peterson Md Pllc 3401 Lockwood Dr Lakeside AZ 85929-5613 Ph: (928) 368-2060 |
| NPI Number | 1043526569 |
|---|---|
| Provider Enumeration Date | 08/21/2010 |
| Last Update Date | 08/21/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043526569 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | AZ23268 (Arizona) | Primary |
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