Mimi M Peterson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

20854 Issued in AZ

Practice address

7507 E. Tanque Verde Rroad
101
Tucson, AZ 85715

Phone

(520) 722-2585

Fax

(520) 722-1097

NPI assigned

Sep 12, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tanque Verde Pediatrics, P.C.

  • Pediatrics Physician
  • Tucson, AZ
  • NPI 1740494186
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1336134758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7507 E. TANQUE VERDE ROAD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85715",
            "telephone_number": "520-722-2585",
            "fax_number": "520-722-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7507 E. TANQUE VERDE RROAD",
            "address_2": "101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85715",
            "telephone_number": "520-722-2585",
            "fax_number": "520-722-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MIMI",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-12",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "20854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Peterson, PHARMD
• Julie Marie Peterson, L.AC. DIPL.AC.
• Margaret Peterson
• Mark Steven Peterson, MD
• Mikael Brian Peterson, PHARMD.
• Paula C Peterson, OD
• Raymond William Peterson Jr., DPM
• Shannon Lynn Peterson, RN
• Sharon Peterson, OD
• Shaun N Peterson, MD

• Pediatrics Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.