Healthcare Provider Details

I. General information

NPI: 1992827869
Provider Name (Legal Business Name): DANIEL M PETERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 MARK DABLING BLVD SUITE 100
COLORADO SPRINGS CO
80918-3839
US

IV. Provider business mailing address

2322 S ACADEMY BLVD
COLORADO SPRINGS CO
80916-2406
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-1584
  • Fax: 719-592-0965
Mailing address:
  • Phone: 719-390-1727
  • Fax: 719-390-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0046019
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: