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General NPI Number Information
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NPI Number | 1013939578
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Entity Type | Individual
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Provider Name | DIANE ELAINE BERGMAN PETERSEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 940 CENTRAL PARK DRIVE #209
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80487
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Country | US
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Telephone | 970-879-3738
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Fax | 970-870-6441
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Provider Business Mailing Address
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Address Line | 940 CENTRAL PARK DRIVE #209
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80487
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Country | US
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Telephone | 970-879-3738
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Fax | 970-870-6441
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30507
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 46731
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License Number State | CO
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