Healthcare Provider Details

I. General information

NPI: 1619066610
Provider Name (Legal Business Name): VERNON L NAAKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 GRANT ST SUITE 410
THORNTON CO
80229-4385
US

IV. Provider business mailing address

9195 GRANT ST SUITE 410
THORNTON CO
80229-4385
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-2229
  • Fax: 303-991-1721
Mailing address:
  • Phone: 303-280-2229
  • Fax: 303-991-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: