Basic Information
| Provider Information | |||||||||
| NPI: | 1134178809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHLHEIMER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1628 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815021628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702441977 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2635 N 7TH ST | ||||||||
| Address2: | ST MARY'S HOSPITAL EMERGENCY DEPARTMENT | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815018209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702441977 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 12/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 39661 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 527664339 | 01 | CO | CHAMPUS | OTHER | 00720330 | 05 | CO | MEDICAID | T0368 | 05 | UT | MEDICAID | 930109417 | 01 | CO | RAILROAD | OTHER |