Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR.0058113 | CO |
N | 207QS0010X | Family Doctor - Sports Medicine | DR.0058113 | CO |
NPI | 1215349642 |
---|---|
Provider Name | Robert Nicolas Petro |
First Address | Englewood, CO 80110-2167 |
Second Address | Englewood, CO 80110-2129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000173212 | (05) | CO |