Provider Demographics
NPI:1871620682
Name:DOUGLAS P PELLER DO LLC
Entity type:Organization
Organization Name:DOUGLAS P PELLER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:PELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-920-1015
Mailing Address - Street 1:9141 GRANT ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4374
Mailing Address - Country:US
Mailing Address - Phone:303-920-1015
Mailing Address - Fax:303-252-1437
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:SUITE 240
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4374
Practice Address - Country:US
Practice Address - Phone:303-920-1015
Practice Address - Fax:303-252-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37826207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63286271Medicaid
CO63286271Medicaid
COG15732Medicare UPIN