Provider Demographics
NPI:1528163979
Name:VAN DER SLOOT, PAUL G (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:VAN DER SLOOT
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 STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-584-8000
Mailing Address - Fax:
Practice Address - Street 1:701 E HAMPDEN AVE STE 225
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2737
Practice Address - Country:US
Practice Address - Phone:303-788-9200
Practice Address - Fax:303-781-4368
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21280207Y00000X
NY252522207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1809555000Medicaid
NY03117264Medicaid
WV1809555000Medicaid
NYJ40003555Medicare PIN