Provider Demographics
NPI:1356443774
Name:ELFENBEIN, DAVID HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
Last Name:ELFENBEIN
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:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1627
Mailing Address - Country:US
Mailing Address - Phone:970-672-1980
Mailing Address - Fax:970-817-2112
Practice Address - Street 1:711 N TAYLOR ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230
Practice Address - Country:US
Practice Address - Phone:970-672-1980
Practice Address - Fax:970-817-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56343207X00000X
CT038451207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
010038451CT01OtherANTHEM BCBS
038451OtherCONNECTICARE
2355159OtherAETNA
1967516OtherUNITED HEALTHCARE
2963655002OtherCIGNA
2V2654OtherHLTHNET OF THE NORTHEAST
CT001384510Medicaid
CO1942708326Medicaid
P2104370OtherOXFORD
H13392Medicare UPIN
2355159OtherAETNA
200000926Medicare ID - Type Unspecified
200040952Medicare PIN