Provider Demographics
NPI:1043275951
Name:EWING, PETER C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:EWING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2995 BASELINE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2318
Mailing Address - Country:US
Mailing Address - Phone:303-443-2544
Mailing Address - Fax:303-443-6475
Practice Address - Street 1:2995 BASELINE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2318
Practice Address - Country:US
Practice Address - Phone:303-443-2544
Practice Address - Fax:303-443-6475
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO16871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01168715Medicaid
COC9658Medicare PIN
COE60776Medicare UPIN