1336126184 NPI number — DR. LAURENCE F GAYNOR M.D

Table of content: DR. LAURENCE F GAYNOR M.D (NPI 1336126184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336126184 NPI number — DR. LAURENCE F GAYNOR M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAYNOR
Provider First Name:
LAURENCE
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336126184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 E GEDDES AVE
Provider Second Line Business Mailing Address:
NO 200
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
303-761-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  18133 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104686150 . This is a "MI MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 179782001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300049135 . This is a "RR MCRE RIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 100257090000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414545970A . This is a "GA MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 7100227240 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7617666 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01181338 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336126184 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200424900A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 922121 . This is a "AZ MEDICAID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 02555484 . This is a "NY MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 053216001 . This is a "TX MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1336126184 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200410090A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84073331 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: XPY201227 . This is a "CA MEDICAID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 100017792 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300089928 . This is a "RR MCRE MIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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