Healthcare Provider Details

I. General information

NPI: 1679523930
Provider Name (Legal Business Name): STEVEN L PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WELLINGTON AVE SUITE 208
GRAND JUNCTION CO
81501-6129
US

IV. Provider business mailing address

2754 COMPASS DR STE 300
GRAND JUNCTION CO
81506-8714
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-1686
  • Fax: 970-254-1687
Mailing address:
  • Phone: 970-254-1686
  • Fax: 970-254-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number35550
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: