Provider Demographics
NPI:1619066610
Name:NAAKE, VERNON L (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:NAAKE
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 1:9195 GRANT ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4385
Mailing Address - Country:US
Mailing Address - Phone:303-280-2229
Mailing Address - Fax:303-991-1721
Practice Address - Street 1:9195 GRANT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4385
Practice Address - Country:US
Practice Address - Phone:303-280-2229
Practice Address - Fax:303-991-1721
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01362359Medicaid
297228Medicare ID - Type Unspecified
CO01362359Medicaid