Provider Demographics
NPI:1881678621
Name:KINNEY, ELIZABETH B (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:B
Last Name:KINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-587-1417
Mailing Address - Fax:719-587-6324
Practice Address - Street 1:19021 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-9410
Practice Address - Country:US
Practice Address - Phone:719-274-5121
Practice Address - Fax:719-274-6003
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO32767207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327675Medicaid
CO01327675Medicaid
F07935Medicare UPIN