Basic Information
| Provider Information | |||||||||
| NPI: | 1417906918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1786 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805221786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556545262 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2555 E 13TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805375136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709990240 | ||||||||
| FaxNumber: | 8172199444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD23231 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | K9868 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | DR.0058816 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 232313 | 05 | SC | MEDICAID | 185651002 | 05 | TX | MEDICAID | 20-23231 | 01 | SC | CDS | OTHER | BP6769648 | 01 | DEA | OTHER |