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General NPI Number Information
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NPI Number | 1922529965
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Entity Type | Individual
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Provider Name | ADAM VAUDREUIL MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 1175 S PERRY ST STE 220
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City | CASTLE ROCK
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State | CO
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Zip | 80104-0017
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Country | US
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Telephone | 720-615-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 9348 GRAND CORDERA PKWY STE 160
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-7023
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Country | US
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Telephone | 719-355-1585
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | DR.0066127
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License Number State | CO
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