Provider Demographics
NPI:1629088414
Name:BJERKE, RANDAL DEAN (MD)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:DEAN
Last Name:BJERKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4770
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:1155 ALPINE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3495
Practice Address - Country:US
Practice Address - Phone:303-444-2150
Practice Address - Fax:303-442-3363
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0020554207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01205541Medicaid
CO442795YLL6Medicare PIN
CO01205541Medicaid
COD23800Medicare UPIN