Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 39661 | CO |
NPI | 1134178809 |
---|---|
Provider Name | Dr. Peter Joseph Dahlheimer |
First Address | Grand Junction, CO 81502-1628 |
Second Address | Grand Junction, CO 81501-8209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 23/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00720330 | (05) | CO |
527664339 | CHAMPUS (01) | CO |
930109417 | RAILROAD (01) | CO |
H49529 | (02) | CO |
T0368 | (05) | UT |