Provider Demographics
NPI:1275571994
Name:VANDERPOOL, VICKY A (MD)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:A
Last Name:VANDERPOOL
Suffix:
Gender:F
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:DEPT 557
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-0557
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:2600 CAMPUS DR
Practice Address - Street 2:STE A
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3357
Practice Address - Country:US
Practice Address - Phone:303-665-1900
Practice Address - Fax:303-926-1781
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01296755Medicaid
P00359278OtherMEDICARE RAILROAD
P00359278OtherMEDICARE RAILROAD
COC806932Medicare PIN