Basic Information
| Provider Information | |||||||||
| NPI: | 1376563353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANGEMERT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 E. MAIN STREET | ||||||||
| Address2: | BUSINESS OPTIONS MEDICAL BUILDING | ||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707650810 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814250529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703236141 | ||||||||
| FaxNumber: | 9703236117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21454 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 16752 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 840874926001 | 01 | CO | ROCKY MOUNTAIN HEALTHPLAN | OTHER | 01214543 | 05 | CO | MEDICAID | RO 666431 | 01 | CO | BLUE CROSS | OTHER | 16752 | 01 | HI | HI STATE LISENCE | OTHER | 453647YS6E | 01 | CO | MEDICARE B PTAN FOR RIVER VALLEY FAMILY HEALTH CENTER | OTHER |