Provider Demographics
NPI:1477641298
Name:CORYELL, LAURIE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANNE
Last Name:CORYELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17230 JACKSON CREEK PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7301
Mailing Address - Country:US
Mailing Address - Phone:719-571-7070
Mailing Address - Fax:719-571-7079
Practice Address - Street 1:17230 JACKSON CREEK PKWY
Practice Address - Street 2:STE 120
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7301
Practice Address - Country:US
Practice Address - Phone:719-571-7070
Practice Address - Fax:719-571-7079
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COCO26821207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01268218Medicaid
COE36235Medicare UPIN
COE6154Medicare PIN