Provider Demographics
NPI:1518974484
Name:WEDEMEYER, STARR RACHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STARR
Middle Name:RACHELLE
Last Name:WEDEMEYER
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 1:8995 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3362
Mailing Address - Country:US
Mailing Address - Phone:720-427-2232
Mailing Address - Fax:
Practice Address - Street 1:8889 FOX DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-8841
Practice Address - Country:US
Practice Address - Phone:303-430-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46043208000000X
CAA93003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31705057Medicaid