Provider Demographics
NPI:1023019627
Name:ELDER, LAURA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANE
Last Name:ELDER
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 1:4215 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4838
Mailing Address - Country:US
Mailing Address - Phone:972-816-7870
Mailing Address - Fax:
Practice Address - Street 1:4215 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4838
Practice Address - Country:US
Practice Address - Phone:972-816-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1039392084P0800X
CODR.00573182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB70428Medicare UPIN
TX00J05WMedicare ID - Type Unspecified