Provider Demographics
NPI:1073772406
Name:ANDERSON ELDER, EMILY R (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:R
Last Name:ANDERSON ELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1709 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:GREENLEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-330-0333
Mailing Address - Fax:970-686-3960
Practice Address - Street 1:1709 61ST AVE.
Practice Address - Street 2:
Practice Address - City:GREENLEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-330-0333
Practice Address - Fax:970-686-3960
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-2825207Q00000X
CO48233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73257567Medicaid
COCOAAA0437Medicare PIN