Provider Demographics
NPI:1023132503
Name:PETERS, RONALD LEWIS (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEWIS
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13951 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3452
Mailing Address - Country:US
Mailing Address - Phone:480-607-7999
Mailing Address - Fax:480-607-7998
Practice Address - Street 1:13951 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3452
Practice Address - Country:US
Practice Address - Phone:480-607-7999
Practice Address - Fax:480-607-7998
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24128Medicare UPIN