Provider Demographics
NPI:1285802769
Name:QUINTERO, PETER S (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:QUINTERO
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 1:1721 E 19TH AVE STE 468
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1242
Mailing Address - Country:US
Mailing Address - Phone:303-863-0501
Mailing Address - Fax:303-863-0497
Practice Address - Street 1:1721 E 19TH AVE STE 468
Practice Address - Street 2:468
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1242
Practice Address - Country:US
Practice Address - Phone:303-863-0501
Practice Address - Fax:303-863-0497
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO159572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01159573Medicaid
CO01159573Medicaid