Healthcare Provider Details

I. General information

NPI: 1851456644
Provider Name (Legal Business Name): PETER EHLERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23968 E HINSDALE PL
AURORA CO
80016-5235
US

IV. Provider business mailing address

23968 E HINSDALE PL
AURORA CO
80016-5235
US

V. Phone/Fax

Practice location:
  • Phone: 877-844-3888
  • Fax: 303-690-7673
Mailing address:
  • Phone: 877-844-3888
  • Fax: 303-690-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1986
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: