Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 15534 | AZ |
N | 207RI0011X | Interventional Cardiology | 15534 | AZ |
NPI | 1134121825 |
---|---|
Provider Name | Dr. Marc A Petein |
First Address | Peoria, AZ 85381-4915 |
Second Address | Peoria, AZ 85381-4915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260464 | (05) | AZ |
E34805 | (02) |