Provider Demographics
NPI:1790784775
Name:ALDORETTA, PETER WARREN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WARREN
Last Name:ALDORETTA
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 1:2635 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8209
Mailing Address - Country:US
Mailing Address - Phone:970-298-2279
Mailing Address - Fax:970-298-2222
Practice Address - Street 1:2635 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8209
Practice Address - Country:US
Practice Address - Phone:970-298-2200
Practice Address - Fax:970-298-2222
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10319R174400000X
CO300592080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02159848Medicaid
UT1790784775Medicaid
LA1988481Medicaid
LA5W900Medicare ID - Type Unspecified
UT1790784775Medicaid
COC810759Medicare PIN