Provider Demographics
NPI:1093845752
Name:MENCONI, LAWRENCE RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RALPH
Last Name:MENCONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1777 LARIMER STREET
Mailing Address - Street 2:AP.#908
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1544
Mailing Address - Country:US
Mailing Address - Phone:303-292-4418
Mailing Address - Fax:303-295-1064
Practice Address - Street 1:1777 LARIMER ST
Practice Address - Street 2:APT.#908
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1592
Practice Address - Country:US
Practice Address - Phone:303-292-4418
Practice Address - Fax:303-295-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO18839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist