Provider Demographics
NPI:1124070735
Name:HERR, ELIZABETH W (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:W
Last Name:HERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3405 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3972
Mailing Address - Country:US
Mailing Address - Phone:303-296-1767
Mailing Address - Fax:303-296-3484
Practice Address - Street 1:3405 DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3972
Practice Address - Country:US
Practice Address - Phone:303-296-7167
Practice Address - Fax:303-296-3484
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29377170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293778Medicaid
CO01293778Medicaid
CO89984Medicare ID - Type Unspecified