Provider Demographics
NPI:1588856116
Name:VANETTEN, LARS (MD)
Entity Type:Individual
Prefix:DR
First Name:LARS
Middle Name:
Last Name:VANETTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LARS
Other - Middle Name:
Other - Last Name:VAN ETTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 JUDYS DREAM LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-8703
Mailing Address - Country:US
Mailing Address - Phone:719-242-5811
Mailing Address - Fax:719-212-2009
Practice Address - Street 1:9 JUDYS DREAM LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-8703
Practice Address - Country:US
Practice Address - Phone:719-242-5811
Practice Address - Fax:719-212-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46518208VP0000X, 207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology