| Organization Name: | AGAVE PODIATRY, LLC |
| NPI Number: | 1023260692 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY MARGARET PETERS (PODIATRIST) |
| Mailing Address: | 10440 E Riggs Rd Suite 160 Sun Lakes |
| State: | AZ US |
| Postal Code: | 852487751 |
| Phone Number: | 4808957600 |
| Fax Number: | 4808957601 |
| NPI Enumeration Date: | 10/15/2008 |
| NPI Last Update Date: | 10/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 0582 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |