Provider Demographics
NPI:1821856741
Name:PETERS, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 E HAMPDEN AVE APT 3115
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7691
Mailing Address - Country:US
Mailing Address - Phone:925-783-1448
Mailing Address - Fax:
Practice Address - Street 1:6300 E HAMPDEN AVE APT 3115
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7691
Practice Address - Country:US
Practice Address - Phone:925-783-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program