Provider Demographics
NPI:1275529802
Name:TORMOHLEN, LAURENCE RICHARD JR (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:RICHARD
Last Name:TORMOHLEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:TORMOHLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14001 E ILIFF AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1405
Mailing Address - Country:US
Mailing Address - Phone:303-996-1020
Mailing Address - Fax:303-751-4514
Practice Address - Street 1:14001 E ILIFF AVE
Practice Address - Street 2:STE 109
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1405
Practice Address - Country:US
Practice Address - Phone:303-996-1020
Practice Address - Fax:303-751-4514
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01348291Medicaid
499728Medicare ID - Type Unspecified
G47946Medicare UPIN