Provider Demographics
NPI:1326416140
Name:KOENIG PA-C, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KOENIG PA-C
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 1:2200 E 104TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4402
Mailing Address - Country:US
Mailing Address - Phone:303-452-2766
Mailing Address - Fax:303-252-8694
Practice Address - Street 1:2200 E 104TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4402
Practice Address - Country:US
Practice Address - Phone:303-452-2766
Practice Address - Fax:303-252-8694
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004394363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical