Provider Demographics
NPI:1174645238
Name:INGLIS, ERIN KENYON (MD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KENYON
Last Name:INGLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1735 S PUBLIC RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7093
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-665-3397
Practice Address - Street 1:1701 W 72ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2721
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:720-565-4128
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0048003207Q00000X
CO000501258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90874226Medicaid
COCOAAA2478Medicare UPIN