Active NPI
Robert Peterson, M.D.
- Otolaryngology Physician
- Mesa, AZ
National Provider Identifier
1902206683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 4524
- Practice address
- 3921 E Nora Cir
Mesa, AZ 85215-1077 - Phone
- (480) 832-7464
- NPI assigned
- Aug 29, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 4524 | AZ | Primary |
Addresses
Primary practice location
3921 E Nora Cir
Mesa, AZ 85215-1077
Mailing address
3921 E Nora Cir
Mesa, AZ 85215-1077
Phone (480) 832-7464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151231000611 | AZ | Order and Referring Only - Otolaryngology | 8325340730 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4524 | AZ | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409270400000",
"number": "1902206683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3921 E NORA CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852151077",
"telephone_number": "480-832-7464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3921 E NORA CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852151077",
"telephone_number": "480-832-7464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-29",
"last_updated": "2014-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "AZ",
"license": "4524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.