Provider Demographics
NPI:1962508531
Name:PEETZ, SHELLEY L (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:PEETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 39TH AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2502
Mailing Address - Country:US
Mailing Address - Phone:970-352-7366
Mailing Address - Fax:970-352-7367
Practice Address - Street 1:2000 70TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8626
Practice Address - Country:US
Practice Address - Phone:970-506-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24743207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01247436Medicaid
CO01247436Medicaid
COC807816Medicare PIN