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General NPI Number Information
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NPI Number | 1215349642
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Entity Type | Individual
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Provider Name | ROBERT NICOLAS PETRO DO
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Gender | Male
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 730 W HAMPDEN AVE STE 200
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2129
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Country | US
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Telephone | 720-974-7464
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Fax | 303-953-7274
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Provider Business Mailing Address
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Address Line | 750 W HAMPDEN AVE STE 105
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2167
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Country | US
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Telephone | 303-341-4730
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Fax | 303-341-4708
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | DR.0058113
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | DR.0058113
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0058113
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License Number State | CO
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