MEDICARE: DR. PETER J. GIACOBBE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	22113	CO

General Provider Information

NPI Number	:	1518985894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J. GIACOBBE M.D.

Provider Business Mailing Address
First Line	:	1805 MAIN ST
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1176
Country	:	US
Telephone Number	:	719-390-7071
Fax Number	:	719-390-5590

Provider Business Practice Location Address
First Line	:	1805 MAIN ST
Second Line	:	SUITE B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1176
Country	:	US
Telephone Number	:	719-390-7071
Fax Number	:	719-390-5590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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