Basic Information
| Provider Information | |||||||||
| NPI: | 1659306579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OUDERKIRK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ERIK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3464 S WILLOW ST | ||||||||
| Address2: | STE 138 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037552900 | ||||||||
| FaxNumber: | 3037550404 | ||||||||
| Practice Location | |||||||||
| Address1: | 2373 CENTRAL PARK BLVD | ||||||||
| Address2: | STE. #201 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802382300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035770110 | ||||||||
| FaxNumber: | 3035770112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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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 | 213E00000X | 585 | CO | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 1200318 | KS | N | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 29473373 | 05 | CO | MEDICAID | 480035364 | 01 | CO | RAILROAD MEDICARE | OTHER |