Provider Demographics
NPI:1972509909
Name:ZILA-EIVINS, SANDRA L (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:ZILA-EIVINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:EIVINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:STE 210
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8816
Mailing Address - Country:US
Mailing Address - Phone:970-871-4811
Mailing Address - Fax:970-879-4527
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:STE 210
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-871-4811
Practice Address - Fax:970-879-4527
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CO36567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01365675Medicaid
CO36567OtherPHYSICIAN LICENSE NUMBER
COG60020Medicare UPIN
CO36567OtherPHYSICIAN LICENSE NUMBER