Basic Information
Provider Information | |||||||||
NPI: | 1720180581 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHURNAS | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | R | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 950 E HARVARD AVE | ||||||||
Address2: | STE 440 | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802107009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037442704 | ||||||||
FaxNumber: | 3037443244 | ||||||||
Practice Location | |||||||||
Address1: | 950 E HARVARD AVE | ||||||||
Address2: | STE 440 | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802107009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037442704 | ||||||||
FaxNumber: | 3037443244 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/02/2006 | ||||||||
LastUpdateDate: | 05/17/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 32232 | CO | Y |   | Allopathic & Osteopathic Physicians | Dermatology |   |
ID Information
ID | Type | State | Issuer | Description | 38305 | 01 | CO | BCBS | OTHER | 01322320 | 05 | CO |   | MEDICAID | 070015072 | 01 | CO | RR MEDICARE | OTHER | 84-1511239 | 01 | CO | FEDERAL TAX ID | OTHER |