MEDICARE: DR. LARS VANETTEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	CDRH.0046518	CO
2	208VP0000X	Pain Medicine Physician	46518	CO

General Provider Information

NPI Number	:	1588856116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARS VANETTEN MD

Provider Business Mailing Address
First Line	:	9 JUDYS DREAM LN
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-8703
Country	:	US
Telephone Number	:	719-242-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E BOULDER ST STE 1183
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5533
Country	:	US
Telephone Number	:	719-365-6999
Fax Number	:	719-365-2837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	05/20/2026

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