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General NPI Number Information
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NPI Number | 1073686762
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Entity Type | Individual
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Provider Name | JEAN VAN DE POLDER M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1646 ELMIRA ST
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City | AURORA
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State | CO
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Zip | 80010-2122
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Country | US
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Telephone | 303-617-2498
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Fax | 303-617-2832
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Provider Business Mailing Address
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Address Line | 11059 E BETHANY DR SUITE 200
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City | AURORA
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State | CO
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Zip | 80014-2622
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Country | US
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Telephone | 303-617-2300
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Fax | 303-617-2397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 18268
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License Number State | CO
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