| Doctor Name: | RON PETERSON |
| NPI Number: | 1245220086 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 55424 |
| Business Practice Address: | 1100 Carson Ave Suite 201 La Junta, CO - 810502751 |
| Business Phone Number: | 7193835900 |
| Business Fax Number: | 7193836533 |
| Mailing Address: | 1100 Carson Ave, Suite 201 LA JUNTA |
| State: | CO |
| Postal Code: | 810502751 |
| Phone Number: | 7193835900 |
| Fax Number: | 7193836533 |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 55424 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |