Provider Demographics
NPI:1417064163
Name:LURIE, REGINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:LURIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2352 MEADOWS BLVD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8405
Mailing Address - Country:US
Mailing Address - Phone:303-688-5226
Mailing Address - Fax:303-814-0717
Practice Address - Street 1:2352 MEADOWS BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8405
Practice Address - Country:US
Practice Address - Phone:303-688-5226
Practice Address - Fax:303-814-0717
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO39920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48608211Medicaid