Provider Demographics
NPI:1730497348
Name:PETERS, JOSHUA SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:PETERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:910-790-9714
Mailing Address - Fax:910-791-1063
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GLENWOOD SPGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4275
Practice Address - Country:US
Practice Address - Phone:970-384-7140
Practice Address - Fax:970-945-0563
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004114207X00000X, 363AS0400X
NC0010-15379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76755517Medicaid
CO382506YS8JMedicare PIN