Provider Demographics
NPI:1609063825
Name:DEITER-ENRIGHT, TARRA LOUISA (DO)
Entity Type:Individual
Prefix:DR
First Name:TARRA
Middle Name:LOUISA
Last Name:DEITER-ENRIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 WYNKOOP ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5560
Mailing Address - Country:US
Mailing Address - Phone:303-243-5010
Mailing Address - Fax:303-389-9332
Practice Address - Street 1:1600 PRAIRIE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4006
Practice Address - Country:US
Practice Address - Phone:303-519-0842
Practice Address - Fax:303-498-2189
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48647208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50734555Medicaid
CO271559YK1COtherMEDICARE PTAN FOR SOUND FOR CENTURA
CO271559YK1COtherMEDICARE PTAN FOR SOUND FOR CENTURA