Provider Demographics
NPI:1740086883
Name:MOUNT MEEKER PEDIATRICS PC
Entity type:Organization
Organization Name:MOUNT MEEKER PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-939-3023
Mailing Address - Street 1:6525 GUNPARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6525 GUNPARK DR STE 320
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3346
Practice Address - Country:US
Practice Address - Phone:720-939-3023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1407241011Medicaid