Provider Demographics
NPI:1730134537
Name:PECHETTE, DOUGLAS R (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:PECHETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 MEADOW DR
Mailing Address - Street 2:#1
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8395
Mailing Address - Country:US
Mailing Address - Phone:303-674-7477
Mailing Address - Fax:303-670-0443
Practice Address - Street 1:28000 MEADOW DR
Practice Address - Street 2:#1
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8395
Practice Address - Country:US
Practice Address - Phone:303-674-7477
Practice Address - Fax:303-670-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO28615207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5502AMPR008177OtherBLUE CROSS
CO01286152Medicaid
E04726Medicare UPIN
CO5502AMPR008177OtherBLUE CROSS