Healthcare Provider Details

I. General information

NPI: 1609839786
Provider Name (Legal Business Name): MELISSA PETERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E ARAPAHOE RD
CENTENNIAL CO
80122-2312
US

IV. Provider business mailing address

7780 S BROADWAY STE 100
LITTLETON CO
80122-2633
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-798-9996
  • Fax: 303-730-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5156
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38154
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: