Healthcare Provider Details

I. General information

NPI: 1457715039
Provider Name (Legal Business Name): CALEB GENE VAN ESSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 03/24/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY SUITE WW-739
SEATTLE WA
98122-4307
US

IV. Provider business mailing address

7117 S WINDERMERE ST
LITTLETON CO
80120-4025
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2123
  • Fax:
Mailing address:
  • Phone: 303-903-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0066057
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: