Individual
JAMES LEE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1025 PENNOCK PL STE 1421, FORT COLLINS, CO 80524
(970) 495-8800
(970) 495-8820
Mailing address
1025 PENNOCK PL STE 1421, FORT COLLINS, CO 80524-3257
(970) 495-8800
(970) 495-8820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1491
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126606300
—
WY
05
—
75979837
—
CO
Enumeration date
04/27/2007
Last updated
11/21/2019
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