Provider Demographics
NPI:1245395649
Name:ANAYA, LAWRENCE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:ANAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1045
Mailing Address - Country:US
Mailing Address - Phone:719-546-3600
Mailing Address - Fax:719-546-0931
Practice Address - Street 1:4020 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1045
Practice Address - Country:US
Practice Address - Phone:719-546-3600
Practice Address - Fax:719-546-0931
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275114Medicaid
COE14214Medicare UPIN
COCL5618Medicare PIN