MEDICARE: JOSHUA SCOTT PETERS PA-C

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	207X00000X	Orthopaedic Surgery Physician	PA0004114	CO
2	363AS0400X	Surgical Physician Assistant	PA0004114	CO
3	363A00000X	Physician Assistant	0010-15379	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730497348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA SCOTT PETERS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	910-790-9714
Fax Number	:	910-791-1063

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVE
Second Line	:	SUITE 206
City	:	GLENWOOD SPGS
State	:	CO
Zip	:	81601-4275
Country	:	US
Telephone Number	:	970-384-7140
Fax Number	:	970-945-0563

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

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	05/27/2025

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