=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518431691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER L DURANTE II MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2019
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 E ARAPAHOE ROAD
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-661-8300
-----------------------------------------------------
Fax | 973-661-8333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19518 E LONG LN
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80016-1912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 17467
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------