Provider Demographics
NPI:1033169511
Name:VENNOS, ELIZABETH MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:VENNOS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-647-2188
Mailing Address - Fax:360-756-0802
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-647-2188
Practice Address - Fax:360-756-0802
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00032564207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G07704Medicare UPIN