Provider Demographics
NPI:1902195969
Name:PROUSE, EMILY R (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:PROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:FRASER
Other - Last Name:ROEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:STE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-320-8499
Mailing Address - Fax:303-320-8620
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:STE 470
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3912
Practice Address - Country:US
Practice Address - Phone:303-320-8499
Practice Address - Fax:303-320-8620
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055793207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49280252Medicaid
CO474814YTU0Medicare PIN