Organization
ACADEMIC NEUROLOGY & HEADACHE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE H PETERS M.D. (PRESIDENT)
(719) 630-1510
Entity
Organization
Contact information
Practice address
2301 E PIKES PEAK AVE, SUITE 202, COLORADO SPRINGS, CO 80909-8006
(719) 630-1510
(719) 632-7343
Mailing address
2301 E PIKES PEAK AVE, COLORADO SPRINGS, CO 80909-8006
(719) 630-1510
(719) 632-7343
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24546
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04016382
—
CO
Enumeration date
04/24/2007
Last updated
12/14/2009
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