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General NPI Number Information
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NPI Number | 1104956945
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Entity Type | Individual
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Provider Name | WENDY M PETERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 2045 FRANKLIN ST
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City | DENVER
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State | CO
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Zip | 80205-5437
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Country | US
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Telephone | 303-338-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 FRANKLIN ST
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City | DENVER
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State | CO
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Zip | 80205-5437
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Country | US
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Telephone | 303-338-4545
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 43578
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License Number State | CO
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