Provider Demographics
NPI:1760585749
Name:ROSE, ELIZABETH CORDES (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CORDES
Last Name:ROSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:CORDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80502-1465
Mailing Address - Country:US
Mailing Address - Phone:405-285-8285
Mailing Address - Fax:405-285-8227
Practice Address - Street 1:4575 BYRD DR RM CM-103
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7198
Practice Address - Country:US
Practice Address - Phone:970-836-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36562084P0800X
CODR.00634292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243529900Medicare ID - Type Unspecified
OKHO7478Medicare UPIN