MEDICARE: MR. GUY P VAN DER WERF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	31317	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538154257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUY P VAN DER WERF MD

Provider Business Mailing Address
First Line	:	555 PROSPECT AVE
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6312
Country	:	US
Telephone Number	:	970-586-2200
Fax Number	:	970-577-4536

Provider Business Practice Location Address
First Line	:	131 STANLEY AVE STE 202
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6356
Country	:	US
Telephone Number	:	970-586-2344
Fax Number	:	970-586-9060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/27/2018

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