Provider Demographics
NPI:1619900842
Name:ELLIOTT, PETER C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:ELLIOTT
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 173891
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3891
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-365-5000
Practice Address - Fax:719-365-6820
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO039971207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO930119408OtherRAILROAD MEDICARE
2370237OtherAETNA
CO84145895001OtherPACIFICARE
CO68554541Medicaid
CO39971OtherCOLORADO LICENSE
COBE3142320OtherDEA
CO930119408OtherRAILROAD MEDICARE
COBE3142320OtherDEA