Healthcare Provider Details

I. General information

NPI: 1407283542
Provider Name (Legal Business Name): PETER M. SCHMID, DO PC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 SUMNER ST SUITE 100
LONGMONT CO
80501-3270
US

IV. Provider business mailing address

1305 SUMNER ST SUITE 100
LONGMONT CO
80501-3271
US

V. Phone/Fax

Practice location:
  • Phone: 303-651-6770
  • Fax: 303-651-6794
Mailing address:
  • Phone: 303-651-6770
  • Fax: 303-651-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number32368
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number32368
License Number StateCO

VIII. Authorized Official

Name: PETER MICHAEL SCHMID
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 303-651-6770