Provider Demographics
NPI:1336126184
Name:GAYNOR, LAURENCE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:F
Last Name:GAYNOR
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 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6278
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO181332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104686150OtherMI MEDICAID
AR179782001Medicaid
CO300049135OtherRR MCRE RIA
NE100257090000Medicaid
GA414545970AOtherGA MEDICAID
KY7100227240Medicaid
NC7617666Medicaid
CO01181338Medicaid
IL1336126184Medicaid
OK200424900AMedicaid
NE84-059792913Medicaid
AZ922121OtherAZ MEDICAID
NY02555484OtherNY MEDICAID
TX053216001OtherTX MEDICAID
WY1336126184Medicaid
KS200410090AMedicaid
NM84073331Medicaid
CAXPY201227OtherCA MEDICAID
WI100017792Medicaid
CO300089928OtherRR MCRE MIC
UT1336126184Medicaid
LA2316265Medicaid
COCW4128Medicare PIN
NC7617666Medicaid
LA2316265Medicaid
TX053216001OtherTX MEDICAID
AZ922121OtherAZ MEDICAID
UT1336126184Medicaid
NE84-059792913Medicaid
NENA1214042Medicare PIN
CAXPY201227OtherCA MEDICAID
GA414545970AOtherGA MEDICAID
NENA1215042Medicare PIN