Provider Demographics
NPI:1194098103
Name:MAYERSON, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MAYERSON
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 1:2000 LITTLE RAVEN ST.
Mailing Address - Street 2:#999
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6199
Mailing Address - Country:US
Mailing Address - Phone:303-903-0930
Mailing Address - Fax:303-295-1895
Practice Address - Street 1:2000 LITTLE RAVEN ST.
Practice Address - Street 2:#999
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6199
Practice Address - Country:US
Practice Address - Phone:303-903-0930
Practice Address - Fax:303-295-1895
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO154062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry