Provider Demographics
NPI:1073620811
Name:GASPAR, LAURIE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:GASPAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5525
Mailing Address - Country:US
Mailing Address - Phone:303-909-4441
Mailing Address - Fax:
Practice Address - Street 1:1800 15TH ST STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4595
Practice Address - Country:US
Practice Address - Phone:970-810-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO378782085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98174240Medicaid
COF72597Medicare PIN