Individual
DR. RYAN DEAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4318 TRAIL BOSS DR STE 100, CASTLE ROCK, CO 80104-7512
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0063473
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029036
KAISER COMMERCIAL NUMBER
CO
05
—
9000147952
—
CO
Enumeration date
05/15/2017
Last updated
06/17/2021
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