Individual
DR. JON LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
0310C COUNTY ROAD 14, DEL NORTE, CO 81132-8719
(719) 657-4102
(719) 657-4106
Mailing address
0310 COUNTY ROAD 14, DEL NORTE, CO 81132-8719
(719) 657-4102
(719) 657-4106
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR-46755
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300686
MEDICARE ID-TYPE UNSPECIFIED
CO
05
—
30126363
—
CO
Enumeration date
06/08/2006
Last updated
11/20/2008
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