MEDICARE: KENT A PETRIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	22520	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265402283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT A PETRIE MD

Provider Business Mailing Address
First Line	:	2700 GILSTRAP CT
Second Line	:	SUITE 230
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-8735
Country	:	US
Telephone Number	:	970-945-2840
Fax Number	:	970-945-2893

Provider Business Practice Location Address
First Line	:	320 BEARD CREEK RD STE 200
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6426
Country	:	US
Telephone Number	:	970-945-2840
Fax Number	:	970-945-2893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/10/2019

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Directions to “ KENT A PETRIE MD” Practice Location

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