Provider Demographics
NPI:1174508279
Name:MORAN, ELIZABETH TRACY (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TRACY
Last Name:MORAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4723
Mailing Address - Country:US
Mailing Address - Phone:303-930-7800
Mailing Address - Fax:303-930-7860
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-684-1900
Practice Address - Fax:303-684-1925
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0000512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S43301Medicare UPIN
CO12358Medicare ID - Type Unspecified