Healthcare Provider Details

I. General information

NPI: 1740086883
Provider Name (Legal Business Name): MOUNT MEEKER PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 GUNPARK DR STE 320
BOULDER CO
80301-3346
US

IV. Provider business mailing address

6525 GUNPARK DR STE 320
BOULDER CO
80301-3346
US

V. Phone/Fax

Practice location:
  • Phone: 720-939-3023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1407241011
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: DR. PRIYA DOKKEN
Title or Position: PHYSICIAN
Credential: DO
Phone: 720-939-3023