Basic Information
| Provider Information | |||||||||
| NPI: | 1487812368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAES | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 RIVERSIDE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702241670 | ||||||||
| FaxNumber: | 9704956218 | ||||||||
| Practice Location | |||||||||
| Address1: | 1683 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805507921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706860124 | ||||||||
| FaxNumber: | 9706860845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 09/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR46032 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.