Healthcare Provider Details

I. General information

NPI: 1619020450
Provider Name (Legal Business Name): ROBERT LOUIS VONGUNTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

2163 S HIGH ST
DENVER CO
80210-4622
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone: 303-778-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26988
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: