Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 35550 | CO |
NPI | 1679523930 |
---|---|
Provider Name | Steven L Peterson |
First Address | Grand Junction, CO 81506-8714 |
Second Address | Grand Junction, CO 81501-6129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H03106 | (02) | |
P00410355 | RAILROAD MEDICARE (01) |