Provider Demographics
NPI:1922071778
Name:EBERLEIN, DUANE (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:EBERLEIN
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 5447
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 GRANT ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4301
Practice Address - Country:US
Practice Address - Phone:303-407-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31589207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1315894Medicaid
COC195958Medicare PIN