Provider Demographics
NPI:1679523930
Name:PETERSON, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2754 COMPASS DR
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8714
Mailing Address - Country:US
Mailing Address - Phone:970-254-1686
Mailing Address - Fax:970-254-1687
Practice Address - Street 1:1120 WELLINGTON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6129
Practice Address - Country:US
Practice Address - Phone:970-254-1686
Practice Address - Fax:970-254-1687
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-08
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Provider Licenses
StateLicense IDTaxonomies
CO355502082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00410355OtherRAILROAD MEDICARE
H03106Medicare UPIN
C808580Medicare PIN