Healthcare Provider Details

I. General information

NPI: 1164500245
Provider Name (Legal Business Name): WILLIAM LEE ELZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 PHAY AVE
CANON CITY CO
81212-2302
US

IV. Provider business mailing address

405 COLLIER RANCH RD
STEPHENVILLE TX
76401-1988
US

V. Phone/Fax

Practice location:
  • Phone: 720-938-5022
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34053
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: