Provider Demographics
NPI:1982684494
Name:VANKOOTEN, DAVID WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:VANKOOTEN
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 1:7850 VANCE DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2118
Mailing Address - Country:US
Mailing Address - Phone:303-431-8881
Mailing Address - Fax:303-431-8564
Practice Address - Street 1:7850 VANCE DR
Practice Address - Street 2:SUITE 225
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2118
Practice Address - Country:US
Practice Address - Phone:303-431-8881
Practice Address - Fax:303-431-8564
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37009207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORRPTAN040013869OtherRAILROAD MEDICARE
CO01370097Medicaid
CO01370097Medicaid
COC507858Medicare PIN