Provider Demographics
NPI:1376563353
Name:VANGEMERT, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:VANGEMERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2233 E. MAIN STREET
Mailing Address - Street 2:BUSINESS OPTIONS MEDICAL BUILDING
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0810
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:308 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425-0529
Practice Address - Country:US
Practice Address - Phone:970-323-6141
Practice Address - Fax:970-323-6117
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-11-30
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Provider Licenses
StateLicense IDTaxonomies
CO21454207Q00000X
HI16752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840874926001OtherROCKY MOUNTAIN HEALTHPLAN
CO01214543Medicaid
CORO 666431OtherBLUE CROSS
HI16752OtherHI STATE LISENCE
CO453647YS6EOtherMEDICARE B PTAN FOR RIVER VALLEY FAMILY HEALTH CENTER
HI16752OtherHI STATE LISENCE
CO453647YS6EOtherMEDICARE B PTAN FOR RIVER VALLEY FAMILY HEALTH CENTER