MEDICARE: DR. ERIC PETERSON 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	38189	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	:	1639179989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC PETERSON MD

Provider Business Mailing Address
First Line	:	777 BANNOCK ST
Second Line	:	MC 1914
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-602-3720
Fax Number	:	303-602-3733

Provider Business Practice Location Address
First Line	:	777 BANNOCK ST
Second Line	:	VC 1914
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-436-6000
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	05/13/2012

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Directions to “ DR. ERIC PETERSON MD” Practice Location

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