MEDICARE: RAYMOND C PETERSEN 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	207R00000X	Internal Medicine Physician	CO47397	CO

General Provider Information

NPI Number	:	1568431781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND C PETERSEN MD

Provider Business Mailing Address
First Line	:	PO BOX 774000-372
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477
Country	:	US
Telephone Number	:	970-819-1881
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 774000-372
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477
Country	:	US
Telephone Number	:	970-819-1881
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/30/2025

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