Provider Demographics
NPI:1356490239
Name:ELGUERA, ELIZABETH DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DENISE
Last Name:ELGUERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ELGUERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1304 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4884
Mailing Address - Country:US
Mailing Address - Phone:772-489-6636
Mailing Address - Fax:772-489-5749
Practice Address - Street 1:1304 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4884
Practice Address - Country:US
Practice Address - Phone:772-489-6636
Practice Address - Fax:772-489-5749
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1222826207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH840ZMedicare UPIN
VA542005321Medicare UPIN