Provider Demographics
NPI:1285618538
Name:EIFERT, EARL DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:DENNIS
Last Name:EIFERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3676 PARKER BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2212
Mailing Address - Country:US
Mailing Address - Phone:719-296-8390
Mailing Address - Fax:719-296-1803
Practice Address - Street 1:3676 PARKER BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2212
Practice Address - Country:US
Practice Address - Phone:719-296-8390
Practice Address - Fax:719-296-1803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01198159Medicaid
COD23668Medicare UPIN
COC445388Medicare ID - Type UnspecifiedPROVIDER NUMBER