Tucker Bag LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

51043 Issued in AZ

Legal business name

TUCKER BAG LLC

Doing business as

Nathan Petersen, M.D.

Practice address

6370 W. Union Hills Dr.
Glendale, AZ 85308

Phone

(623) 414-3500

Fax

(623) 374-2549

NPI assigned

May 19, 2016

Organization subpart

No

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

Authorized official

Name

Nathan Jeffrey Petersen, M.D.

Title

Member

Phone

(623) 414-3500

Specialties & licenses 1

Addresses

Other names 1

• Nathan Petersen, M.D. Doing business as

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

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1336596345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6370 W. UNION HILLS DR.",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-414-3500",
            "fax_number": "623-374-2549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6370 W. UNION HILLS DR.",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-414-3500",
            "fax_number": "623-374-2549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUCKER BAG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "623-414-3500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "51043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nathan Petersen, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Dee Tschetter, PHD
• Nathaniel Tschudy, ND
• Shakeda Tsinnie
• Adrian Tsosie
• Eric Tubat, DNP, PMHNP
• Aremy Dianne Tucker, RN
• Michael Ned Tucker, PA-C
• Amalia Tulbure, FNP-C
• Padmavathy Tummala, M.D.
• Pawanvir Singh Tung, PA-C

• Obstetrics & Gynecology Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Obstetrics & Gynecology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; 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.