Provider Demographics
NPI:1912953498
Name:GAUER, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 YELLOWSTONE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9309
Mailing Address - Country:US
Mailing Address - Phone:307-578-2277
Mailing Address - Fax:307-578-2247
Practice Address - Street 1:424 YELLOWSTONE AVE STE 140
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9309
Practice Address - Country:US
Practice Address - Phone:307-578-2277
Practice Address - Fax:307-578-2247
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040281207R00000X, 207RC0000X, 207RI0011X
IA39253207RC0000X
WY14224A207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71960OtherMEDICARE GROUP