Provider Demographics
NPI:1114995024
Name:VANZURA, ERIC JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOSEPH
Last Name:VANZURA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5341
Mailing Address - Country:US
Mailing Address - Phone:720-259-4609
Mailing Address - Fax:844-704-5808
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:STE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3304
Practice Address - Country:US
Practice Address - Phone:720-259-4609
Practice Address - Fax:844-704-5808
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0038620204D00000X, 207Q00000X
CO38620208M00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27625737Medicaid
H43073Medicare UPIN