Provider Demographics
NPI:1609839786
Name:PETERS, MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 S BROADWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2633
Mailing Address - Country:US
Mailing Address - Phone:303-798-9996
Mailing Address - Fax:303-730-1145
Practice Address - Street 1:5555 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2312
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5156207R00000X
CO38154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK200048563OtherTAX ID
AKDC5515OtherMEDICARE RAILROAD
AKMD3818Medicaid
CO018901OtherKAISER COMMERCIAL NUMBER
CO31676774Medicaid
AK610518100OtherDEPARTMENT OF LABOR
AK610518100OtherDEPARTMENT OF LABOR
AKDC5515OtherMEDICARE RAILROAD
COCO301412Medicare PIN