Provider Demographics
NPI:1508842451
Name:FENTON, LAURA Z (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:Z
Last Name:FENTON
Suffix:
Gender:F
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:303-493-7202
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO369522085R0202X
CODR.00369522085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA667418761AMedicaid
NM60037750Medicaid
CO01369529Medicaid
KS100364650BMedicaid
AZ525115Medicaid
COP00123278OtherRR MCRE MIC
MT1508842451Medicaid
ID805662900Medicaid
CAXPY203764Medicaid
MI104686104Medicaid
COP00123269OtherRR MCRE DIA
IA1546820Medicaid
TX060974502Medicaid
OK100020300AMedicaid
WY114854100Medicaid
COP00123276OtherRR MCRE RIA
COP00123276OtherRR MCRE RIA
MI104686104Medicaid
CAXPY203764Medicaid
COG72562Medicare UPIN