Provider Demographics
NPI:1518985894
Name:GIACOBBE, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:GIACOBBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1805 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1176
Mailing Address - Country:US
Mailing Address - Phone:719-390-7071
Mailing Address - Fax:719-390-5590
Practice Address - Street 1:1805 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1176
Practice Address - Country:US
Practice Address - Phone:719-390-7071
Practice Address - Fax:719-390-5590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO22113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33801Medicare ID - Type Unspecified
COD28287Medicare UPIN