Healthcare Provider Details

I. General information

NPI: 1720047210
Provider Name (Legal Business Name): PETER G HOVLAND MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE SUITE 155
DENVER CO
80210-5073
US

IV. Provider business mailing address

850 E HARVARD AVE SUITE 155
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-778-1910
  • Fax: 303-698-2694
Mailing address:
  • Phone: 303-778-1910
  • Fax: 303-698-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number220670
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number220670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: