Individual
PETER JAY IENATSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2610 TENDERFOOT HILL ST, COLORADO SPRINGS, CO 80906-3981
(719) 522-1133
(719) 576-2025
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3253
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004947
CO
363A00000X
Physician Assistant
PA05044
TX
363AM0700X
Medical Physician Assistant
Primary
PA0004947
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000168915
—
CO
01
—
PA0004947
COLORADO MEDICAL BOARD
CO
01
—
PA05044
TX LICENSE
TX
Enumeration date
02/23/2007
Last updated
04/22/2026
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