Jon Lee Peterson, MD
Individual provider Active NPI Family Medicine Physician · Del Norte, CO
NPI 1043250640 · NPPES record last updated Nov 20, 2008
Key facts
- NPI
- 1043250640
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- DR-46755 (CO)
- Practice address
- 0310C County Road 14
Del Norte, CO 81132-8719 - Phone
- (719) 657-4102
- Fax
- (719) 657-4106
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR-46755 | CO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hermann Neighborhood Health Centers, PLLC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- jonp@ahis.amritamedicaldirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DR-46755 | CO | Yes |
Addresses
Primary practice location
0310C County Road 14
Del Norte, CO 81132-8719
Mailing address
0310 County Road 14
Del Norte, CO 81132-8719
Phone (719) 657-4102
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300686 | Other | CO | MEDICARE ID-TYPE UNSPECIFIED |
| 30126363 | Medicaid | CO |
Other providers in Del Norte, CO
- Lutheran Hospital Association of the San Luis Valley
- Lutheran Hospital Association of the San Luis Valley
- Daniel Macdougall
- Obstetrix Medical Group of Colorado, P.C.
- Debra S Parra
- Heather Madigan Pollock Green
- Rick Rabon
- Thomas Kevin Rice
- Christopher D Riddick
- Rio Grande Oltc
All providers in Del Norte, CO · Family Medicine Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.