Healthcare Provider Details

I. General information

NPI: 1932546405
Provider Name (Legal Business Name): HERMAN CHARLES PETERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 5017
COLORADO SPRINGS CO
80907-6865
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8040
  • Fax: 719-776-6820
Mailing address:
  • Phone: 804-828-7874
  • Fax: 804-827-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0116031430
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberDR.0064119
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: