Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 16954 | CO |
NPI | 1790987410 |
---|---|
Provider Name | Gary Duane Vanderark |
First Address | Englewood, CO 80262 |
Second Address | Englewood, CO 80113-7116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |