Provider Demographics
NPI:1538154257
Name:VAN DER WERF, GUY P (MD)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:P
Last Name:VAN DER WERF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:555 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6312
Mailing Address - Country:US
Mailing Address - Phone:970-586-2200
Mailing Address - Fax:970-577-4536
Practice Address - Street 1:131 STANLEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6356
Practice Address - Country:US
Practice Address - Phone:970-586-2344
Practice Address - Fax:970-586-9060
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2018-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1313170Medicaid
CO01313170Medicaid
CO1313170Medicaid
CO01313170Medicaid