Provider Demographics
NPI:1083690648
Name:ELZINGA, HANS D (MD)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:D
Last Name:ELZINGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-286-4560
Mailing Address - Fax:303-286-4589
Practice Address - Street 1:220 E ROGERS RD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6027
Practice Address - Country:US
Practice Address - Phone:303-776-3250
Practice Address - Fax:303-682-9269
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87837731Medicaid
CO87837731Medicaid