Provider Demographics
NPI:1083154538
Name:CAIN, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 W HAMPDEN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:CO
Mailing Address - Zip Code:80110-3282
Mailing Address - Country:US
Mailing Address - Phone:303-789-5933
Mailing Address - Fax:
Practice Address - Street 1:2677 W HAMPDEN AVE STE B
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:CO
Practice Address - Zip Code:80110-3282
Practice Address - Country:US
Practice Address - Phone:303-789-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29904450-0000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies