Provider Demographics
NPI:1740286897
Name:BROZOVICH, ELISABETH M (PAC)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:M
Last Name:BROZOVICH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 911416
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1416
Mailing Address - Country:US
Mailing Address - Phone:970-668-5584
Mailing Address - Fax:970-262-2196
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-5584
Practice Address - Fax:970-262-2196
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07170004Medicaid
G5568Medicare ID - Type Unspecified
CO07170004Medicaid