Provider Demographics
NPI:1215349642
Name:PETRO, ROBERT NICOLAS (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:NICOLAS
Last Name:PETRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W HAMPDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2167
Mailing Address - Country:US
Mailing Address - Phone:303-341-4730
Mailing Address - Fax:303-341-4708
Practice Address - Street 1:730 W HAMPDEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2129
Practice Address - Country:US
Practice Address - Phone:720-974-7464
Practice Address - Fax:303-953-7274
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058113251E00000X, 207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No251E00000XAgenciesHome HealthGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000173212Medicaid
CO1215349642OtherNOT SURE; WAS GIVEN IN RESIDENCY