Provider Demographics
NPI:1326044215
Name:JANES, PETER C (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:JANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3199
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-3199
Mailing Address - Country:US
Mailing Address - Phone:970-241-0202
Mailing Address - Fax:970-245-0250
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:STE 180
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-3633
Practice Address - Fax:970-668-4406
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28089207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280890Medicaid
COD25039Medicare UPIN
CO465528Medicare ID - Type Unspecified