Provider Demographics
NPI:1518983600
Name:LANDRY, ELAINE T (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:T
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:T
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2005 FRANKLIN ST
Mailing Address - Street 2:MIDTOWN 1, SUITE 750
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5401
Mailing Address - Country:US
Mailing Address - Phone:303-837-7160
Mailing Address - Fax:303-837-6632
Practice Address - Street 1:2005 FRANKLIN ST
Practice Address - Street 2:MIDTOWN 1, SUITE 750
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5401
Practice Address - Country:US
Practice Address - Phone:303-837-7160
Practice Address - Fax:303-837-6632
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44357207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09926071Medicaid
COC805311Medicare PIN
I13220Medicare UPIN