Provider Demographics
NPI:1700972809
Name:SPIDELL, ELIZABETH FLOOD (DO)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:FLOOD
Last Name:SPIDELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:FLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:978 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1839
Mailing Address - Country:US
Mailing Address - Phone:970-963-3350
Mailing Address - Fax:970-963-1082
Practice Address - Street 1:1340 HWY. 133
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623
Practice Address - Country:US
Practice Address - Phone:970-963-3350
Practice Address - Fax:970-963-2958
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62556061Medicaid
CO807740Medicare PIN
CO62556061Medicaid
CO17430Medicare UPIN