Provider Demographics
NPI:1235440595
Name:GARCIA, ELENA DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:DEBRA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:GARCIA
Other - Last Name:EWERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 BANNOCK ST MAIL CODE 0108
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:303-436-7142
Mailing Address - Fax:303-436-7541
Practice Address - Street 1:777 BANNOCK ST MAIL CODE 0108
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-436-7142
Practice Address - Fax:303-436-7541
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52522207P00000X
COTL3718207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50428063Medicaid
CO023764OtherKAISER COMMERCIAL NUMBER
CO023764OtherKAISER COMMERCIAL NUMBER