Doctor Name: | DR. GREGORY WAYNE PETERSBURG |
NPI Number: | 1225167281 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 3714 |
Business Practice Address: | 10371 N Oracle Rd Suite 205 Oro Valley, AZ - 857379392 |
Business Phone Number: | 5202291900 |
Business Fax Number: | 5207422900 |
Mailing Address: | 10371 N Oracle Rd, Suite 205 ORO VALLEY |
State: | AZ |
Postal Code: | 857379392 |
Phone Number: | 5202291900 |
Fax Number: | 5207422900 |
NPI Enumeration Date: | 03/05/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | 3714 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |