Healthcare Provider Details

I. General information

NPI: 1376563353
Provider Name (Legal Business Name): ROBERT J VANGEMERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MAIN STREET
OLATHE CO
81425-0529
US

IV. Provider business mailing address

2233 E. MAIN STREET BUSINESS OPTIONS MEDICAL BUILDING
MONTROSE CO
81401-3831
US

V. Phone/Fax

Practice location:
  • Phone: 970-323-6141
  • Fax: 970-323-6117
Mailing address:
  • Phone: 970-765-0810
  • Fax: 970-497-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21454
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16752
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: