Tony Leroy Peterson
Oral and Maxillofacial Surgeon
1050 S 8th St
Colorado Springs
, Colorado 80905-7307
Tony Leroy Peterson
Oral and Maxillofacial Surgeon
1050 S 8th St
Colorado Springs
, Colorado 80905-7307
(719) 633-8455
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Tony Leroy Peterson
- 1050 S 8th St
- Colorado Springs, CO
- Zip : 80905-7307
- Phone : (719) 633-8455
Second Address
- Tony Leroy Peterson
- 1050 S 8th St
- Colorado Springs, CO
- Zip : 80905-7307
- Phone : (719) 633-8455
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 10364 | CO |
| N | 1223S0112X | Oral and Maxillofacial Surgeon | 1236 | WY |
National Provider Identifier
| NPI | 1053302075 |
|---|---|
| Provider Name | Tony Leroy Peterson |
| First Address | Colorado Springs, CO 80905-7307 |
| Second Address | Colorado Springs, CO 80905-7307 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 31/10/2005 |
| Last Update Date | 29/01/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| VAD000 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.