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General NPI Number Information
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NPI Number | 1437404308
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Entity Type | Organization
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Legal Business Name | VERNON R VAN VONDEREN, MD MPH PC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 34061 FOREST PARK DR
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City | ELIZABETH
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State | CO
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Zip | 80107-7842
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Country | US
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Telephone | 303-646-4071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 397
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City | ELIZABETH
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State | CO
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Zip | 80107-0397
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Country | US
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Telephone | 303-646-4071
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VERNON ROY VAN VONDEREN
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Credential | M.D.
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Telephone | 303-646-7071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 38059
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License Number State | CO
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