Provider Demographics
NPI:1174567861
Name:VANDERKOOI, RUTH ANITA (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANITA
Last Name:VANDERKOOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANITA
Other - Last Name:BOSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD # 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:8350 WCR 13 UNIT 160
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6803
Practice Address - Country:US
Practice Address - Phone:303-689-5160
Practice Address - Fax:303-689-5175
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01313154Medicaid
CO01313154Medicaid
COCOA104792Medicare PIN
COC524368Medicare PIN