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DR. JON LEE PETERSON MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1043250640

Individual Registrant:
DR. JON LEE PETERSON MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
0310C COUNTY ROAD 14  DEL NORTE, CO 81132-8719 US
Tel: 719-657-4102  Fax: 719-657-4106

Contact information for business:
0310 COUNTY ROAD 14  DEL NORTE, CO 81132-8719 US
Tel: 719-657-4102  Fax: 719-657-4106

Registration Information:
NPI: 1043250640
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
CODR-46755

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
MEDICARE ID-TYPE UNSPECIFIED300686CO01
30126363CO05




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