Healthcare Provider Details

I. General information

NPI: 1407844053
Provider Name (Legal Business Name): TOMM VANDERHORST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9830 WEST I-70 FRONTAGE RD SOUTH
WHEAT RIDGE CO
80033
US

IV. Provider business mailing address

9830 WEST I-70 FRONTAGE RD SOUTH
WHEAT RIDGE CO
80033
US

V. Phone/Fax

Practice location:
  • Phone: 303-467-4100
  • Fax: 303-420-0836
Mailing address:
  • Phone: 303-467-4100
  • Fax: 303-420-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49492
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: