Individual
DR. EDWIN R NOORDEWIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2454
(970) 350-2447
Mailing address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2454
(970) 350-2447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29737
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01297373
—
CO
05
—
100263923-00
—
NE
05
—
122698300
—
WY
05
—
128166
—
AZ
05
—
200390030A
—
KS
05
—
81581882
—
NM
01
—
P00931165
MEDICARE RAILROAD CARRIER PTAN
CO
05
—
Z3282
—
UT
Enumeration date
02/15/2006
Last updated
01/03/2017
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