Provider Demographics
NPI:1093211484
Name:VAN MAANEN, TREY (MD)
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:
Last Name:VAN MAANEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W COUNTY LINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2321
Mailing Address - Country:US
Mailing Address - Phone:303-795-5980
Mailing Address - Fax:
Practice Address - Street 1:206 W COUNTY LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2321
Practice Address - Country:US
Practice Address - Phone:303-795-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0065408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program