Provider Demographics
NPI:1821096447
Name:ELLIS, SARAH PEYTON (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:PEYTON
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6021
Mailing Address - Country:US
Mailing Address - Phone:303-940-1867
Mailing Address - Fax:303-940-1894
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6021
Practice Address - Country:US
Practice Address - Phone:303-940-1867
Practice Address - Fax:303-940-1894
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38350207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66308321Medicaid
CO04012365Medicaid
CO160057521OtherRAIL ROAD MEDICARE
CO455598Medicare PIN
CO160057521OtherRAIL ROAD MEDICARE