Provider Demographics
NPI:1336451319
Name:VANCE, HEATHER BIDGOLI (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:BIDGOLI
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BIDGOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:ATTN MARTY TRAHAN
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3573
Mailing Address - Country:US
Mailing Address - Phone:303-440-3122
Mailing Address - Fax:303-440-3282
Practice Address - Street 1:80 HEALTH PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9584
Practice Address - Country:US
Practice Address - Phone:303-666-2722
Practice Address - Fax:303-673-0438
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine