1073669677 NPI number — ELIZABETH JO GILLESPIE MD

Table of content: ELIZABETH JO GILLESPIE MD (NPI 1073669677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073669677 NPI number — ELIZABETH JO GILLESPIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLESPIE
Provider First Name:
ELIZABETH
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EGELHOFF
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073669677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 BANNOCK ST
Provider Second Line Business Mailing Address:
4TH FLOOR MC 4000
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80204-4506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-602-5011
Provider Business Mailing Address Fax Number:
303-602-5056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 BANNOCK ST
Provider Second Line Business Practice Location Address:
4TH FLOOR MC 4000
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80204-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-602-5011
Provider Business Practice Location Address Fax Number:
303-602-5056
Provider Enumeration Date:
01/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  MD2011-0621 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD040906 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X , with the licence number: TL-2014 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)