Active NPI
Joseph William Van Derveer III, M.D.
- Psychiatry Physician
- Boulder, CO
National Provider Identifier
1235321449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 38540
- Practice address
- 954 North St
Suite 202
Boulder, CO 80304-3307 - Phone
- (303) 260-9685
- NPI assigned
- Aug 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 38540 | CO | Primary |
Addresses
Primary practice location
954 North St
Suite 202
Boulder, CO 80304-3307
Mailing address
954 North St
Suite 202
Boulder, CO 80304-3307
Phone (303) 260-9685
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38540 | CO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186790400000",
"number": "1235321449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "954 NORTH ST",
"address_2": "SUITE 202",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043307",
"telephone_number": "303-260-9685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "954 NORTH ST",
"address_2": "SUITE 202",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043307",
"telephone_number": "303-260-9685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DERVEER",
"first_name": "JOSEPH",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-11",
"last_updated": "2007-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CO",
"license": "38540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.