Healthcare Provider Details

I. General information

NPI: 1114121282
Provider Name (Legal Business Name): STEVEN L PETERSON PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
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 Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number35550
License Number StateCO

VIII. Authorized Official

Name: STEVEN L PETERSON
Title or Position: OWNER
Credential: MD
Phone: 970-254-1686