Healthcare Provider Details

I. General information

NPI: 1871620682
Provider Name (Legal Business Name): DOUGLAS P PELLER DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9141 GRANT ST SUITE 240
THORNTON CO
80229-4374
US

IV. Provider business mailing address

9141 GRANT ST SUITE 240
THORNTON CO
80229-4374
US

V. Phone/Fax

Practice location:
  • Phone: 303-920-1015
  • Fax: 303-252-1437
Mailing address:
  • Phone: 303-920-1015
  • Fax: 303-252-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number37826
License Number StateCO

VIII. Authorized Official

Name: DR. DOUGLAS P PELLER
Title or Position: PHYSICIAN AND SURGEON
Credential: D.O.
Phone: 303-920-1015