Provider Demographics
NPI:1407844053
Name:VANDERHORST, TOMM (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMM
Middle Name:
Last Name:VANDERHORST
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 1:9830 WEST I-70 FRONTAGE RD SOUTH
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-467-4100
Mailing Address - Fax:303-420-0836
Practice Address - Street 1:9830 WEST I-70 FRONTAGE RD SOUTH
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-467-4100
Practice Address - Fax:303-420-0836
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3239940Medicaid
MIOM56180002Medicare ID - Type Unspecified
MI3239940Medicaid