Provider Demographics
NPI:1003986720
Name:WRIGHT, LAUREL ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2700
Practice Address - Country:US
Practice Address - Phone:719-543-4000
Practice Address - Fax:719-543-1041
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO39351207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72332379Medicaid
CO293580YK2DMedicare PIN
438388Medicare UPIN