MEDICARE: ELIZABETH A EHRHARDT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	37792	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689655409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A EHRHARDT MD

Provider Business Mailing Address
First Line	:	1910 LAKE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-3322
Country	:	US
Telephone Number	:	719-583-2330
Fax Number	:	719-583-2670

Provider Business Practice Location Address
First Line	:	1910 LAKE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-3322
Country	:	US
Telephone Number	:	719-583-2330
Fax Number	:	719-583-2670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/10/2024

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