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Individual

PAUL STEPHEN PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
5731 SILVERSTONE TER STE 100, COLORADO SPRINGS, CO 80919-3594
(719) 636-3333
(719) 636-0025
Mailing address
5731 SILVERSTONE TER STE 100, COLORADO SPRINGS, CO 80919-3594
(719) 636-3333
(719) 636-0025

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002714
GA
363A00000X
Physician Assistant
Primary
PA0005173
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000687068A
GA
Enumeration date
05/29/2008
Last updated
01/23/2019
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