Healthcare Provider Details

I. General information

NPI: 1689655409
Provider Name (Legal Business Name): ELIZABETH A EHRHARDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LAKE AVE
PUEBLO CO
81004-3322
US

IV. Provider business mailing address

1910 LAKE AVE
PUEBLO CO
81004-3322
US

V. Phone/Fax

Practice location:
  • Phone: 719-583-2330
  • Fax: 719-583-2670
Mailing address:
  • Phone: 719-583-2330
  • Fax: 719-583-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: