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NPI Code Detail

MEDICARE: DR. EDWARD THOMAS PETEROY

MEDICARE: DR. EDWARD THOMAS PETEROY
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
1103TC0700XClinical Psychologist970CO

General Provider Information

NPI Number : 1891891131
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD THOMAS PETEROY
Provider Business Mailing Address
First Line : PO BOX 1562
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80901-1562
Country : US
Telephone Number : 719-599-7882
Fax Number : 719-598-1437
Provider Business Practice Location Address
First Line : 1935 DOMINION WAY
Second Line : SUITE A102
City : COLORADO SPRINGS
State : CO
Zip : 80918-1464
Country : US
Telephone Number : 719-599-7882
Fax Number : 719-598-1437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 07/08/2007

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Directions to “ DR. EDWARD THOMAS PETEROY ” Practice Location

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