Provider Demographics
NPI:1992729891
Name:ELLIOTT, LOIS A (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3366
Mailing Address - Country:US
Mailing Address - Phone:970-867-3885
Mailing Address - Fax:970-867-3864
Practice Address - Street 1:931 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3366
Practice Address - Country:US
Practice Address - Phone:970-867-3885
Practice Address - Fax:970-867-3864
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO668587OtherBLUE CROSS/BLUE SHIELD
CO57723575Medicaid
CO57723575Medicaid
CO668587OtherBLUE CROSS/BLUE SHIELD
COI06225Medicare UPIN