Provider Demographics
NPI:1093813511
Name:AVNER, SANFORD ELDON (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:ELDON
Last Name:AVNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:STE. #400
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-706-9923
Mailing Address - Fax:303-706-0904
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:STE. #400
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-706-9923
Practice Address - Fax:303-706-0904
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR16544207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01165448Medicaid
CO01165448Medicaid
COC550698Medicare PIN