Provider Demographics
NPI:1093772147
Name:ALLGOOD, ELAINE Z (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:Z
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:Z
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1104 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1730
Mailing Address - Country:US
Mailing Address - Phone:314-799-7831
Mailing Address - Fax:
Practice Address - Street 1:1104 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1730
Practice Address - Country:US
Practice Address - Phone:314-799-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J24207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00288834OtherPALMETTO RR MEDICARE
MO003014400Medicare ID - Type Unspecified
MOF31340Medicare UPIN