Basic Information
| Provider Information | |||||||||
| NPI: | 1316077506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MARS | ||||||||
| OtherFirstName: | PETER | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 205 S MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
| FaxNumber: | 3037747899 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 S MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
| FaxNumber: | 3037747899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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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 | 2083P0500X | 36685 | CO | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.