Healthcare Provider Details

I. General information

NPI: 1609867183
Provider Name (Legal Business Name): PETER EDMUND RAZMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/11/2023
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311A N MILDRED RD
CORTEZ CO
81321
US

IV. Provider business mailing address

1311A N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 970-564-2678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD2012-0666
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036077461
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036077461
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD2012-0666
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMC-1402
License Number StateID
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD2012-0666
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: