Provider Demographics
NPI:1194970350
Name:VAN DOORNINCK, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:VAN DOORNINCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-832-2344
Mailing Address - Fax:303-832-3721
Practice Address - Street 1:2055 N HIGH ST
Practice Address - Street 2:#340
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-832-2344
Practice Address - Fax:303-832-3721
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA802302080P0207X
CO486412080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1194970350Medicaid
NM06207219Medicaid
SD1194970350Medicaid
CO98500546Medicaid
NE10025570100Medicaid