Provider Demographics
NPI:1851564462
Name:PHAN, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7780 S BROADWAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2648
Mailing Address - Country:US
Mailing Address - Phone:303-795-3375
Mailing Address - Fax:303-795-0621
Practice Address - Street 1:7780 S BROADWAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2648
Practice Address - Country:US
Practice Address - Phone:303-795-3375
Practice Address - Fax:303-795-0621
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO53781208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery