Basic Information
| Provider Information | |||||||||
| NPI: | 1194935023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | EUN HAE RICE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6325 HOSPITAL PKWY | ||||||||
| Address2: | |||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300975775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784747388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 COOK ST STE 310 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802065339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033724010 | ||||||||
| FaxNumber: | 3033724011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DR.0050165 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 68196 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 55085768 | 05 | CO | MEDICAID |