IndividualActive
Mark Peterson, MD
NPI 1629129168 · Family Medicine Physician · Winslow, AZ
Provider details
- NPI number
- 1629129168
- Entity type
- Individual
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 2304 (AK)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
500 Indiana Ave
Winslow, AZ 86047-2169
Phone: (928) 289-4646
Fax: (928) 289-6229
Approximate (ZIP-level) locationGet directions
Mailing address
500 Indiana Ave
Winslow, AZ 86047-2169
Registry dates
- Enumerated
- 2007-01-12
- Last updated
- 2014-05-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.