Provider Demographics
NPI:1407821960
Name:PRENGER, ERIN C (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:C
Last Name:PRENGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E. GEDDES AVE SUITE 200
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6278
Practice Address - Street 1:10700 E. GEDDES AVE SUITE 200
Practice Address - Street 2:ATTN CREDENTIALING
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6278
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34842085N0700X, 2085R0202X
CO328272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84059792913Medicaid
AZ1Z7046OtherHEALTH NET OF AZ
CO01328277Medicaid
NE84089712600Medicaid
AZAZ0861410OtherBCBSAZ
AZXPY193671OtherMEDI-CAL MEDICAID
AZ481846Medicaid
AZAZ0861410OtherBCBSAZ
AZ300104885Medicare UPIN
AZ1Z7046OtherHEALTH NET OF AZ
COCOA100870Medicare PIN
AZ481846Medicaid
NE84089712600Medicaid