Individual
DR. LYLE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1209 MAREN COVE, FORT COLLINS, CO 80525
(970) 221-6428
Mailing address
1209 MAREN COVE, FORT COLLINS, CO 80525
(970) 221-6428
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
035729
GA
Other
Enumeration date
09/01/2006
Last updated
07/08/2007
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