Provider Demographics
NPI:1437283074
Name:PETERS, BRENT TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:TYLER
Last Name:PETERS
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 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-669-6100
Mailing Address - Fax:970-619-6190
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-619-6100
Practice Address - Fax:970-619-6190
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0046291207RP1001X, 207RC0200X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27153240Medicaid
WY126606300Medicaid
COCO300666Medicare PIN
CO269007YLB8Medicare PIN
WYW23261Medicare PIN
WY126606300Medicaid