Provider Demographics
NPI:1083754600
Name:PELLER, DOUGLAS PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:PELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9141 GRANT STREET, SUITE 240
Mailing Address - Street 2:SUITE 240
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:303-920-1015
Mailing Address - Fax:303-252-1437
Practice Address - Street 1:9141 GRANT STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-920-1015
Practice Address - Fax:303-252-1437
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37826207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63286271Medicaid
CO63286271Medicaid
COG15732Medicare UPIN