Organization
PEDIATRICS 5280, PC
Active
Other names
Pediatrics DTC, PC
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE RIPPERTON (ADMINISTRATOR)
(303) 779-5437
Entity
Organization
Contact information
Practice address
2352 MEADOWS BLVD, SUITE 150, CASTLE ROCK, CO 80109
(303) 779-5437
Mailing address
9094 E MINERAL CIR, STE 120, CENTENNIAL, CO 80112-7200
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04013280
—
CO
Enumeration date
03/12/2014
Last updated
03/12/2014
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