Provider Demographics
NPI:1962400341
Name:LEMIS, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:LEMIS
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 1:360 PEAK ONE DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:970-668-9772
Mailing Address - Fax:970-668-9774
Practice Address - Street 1:360 PEAK ONE DR
Practice Address - Street 2:SUITE 390
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-9772
Practice Address - Fax:970-668-9774
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043013E207RC0000X
CODR.0049206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1144883Medicaid
411332FONMedicare ID - Type Unspecified
PA1144883Medicaid