Provider Demographics
NPI:1922529965
Name:VAUDREUIL, ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:VAUDREUIL
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 1:9348 GRAND CORDERA PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7023
Mailing Address - Country:US
Mailing Address - Phone:719-355-1585
Mailing Address - Fax:
Practice Address - Street 1:1175 S PERRY ST STE 220
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-0017
Practice Address - Country:US
Practice Address - Phone:720-615-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2021-12-29
Deactivation Date:2018-07-11
Deactivation Code:
Reactivation Date:2018-07-18
Provider Licenses
StateLicense IDTaxonomies
CODR.0066127207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology