Provider Demographics
NPI:1629103585
Name:NICHOLSON, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:NICHOLSON
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 1:8406 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3810
Mailing Address - Country:US
Mailing Address - Phone:303-428-7571
Mailing Address - Fax:303-428-3587
Practice Address - Street 1:8406 CLAY ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3810
Practice Address - Country:US
Practice Address - Phone:303-428-7571
Practice Address - Fax:303-428-3587
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32584OtherMEDICAL LICENCE
CO01325844Medicaid
CO32584OtherMEDICAL LICENCE
CO66581Medicare ID - Type Unspecified