Provider Demographics
NPI:1912185604
Name:LAURA C ANDERSON MD, PROFESSIONAL LLC
Entity Type:Organization
Organization Name:LAURA C ANDERSON MD, PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR./MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-300-0220
Mailing Address - Street 1:4900 CHERRY CREEK SOUTH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2283
Mailing Address - Country:US
Mailing Address - Phone:303-300-0220
Mailing Address - Fax:303-300-9612
Practice Address - Street 1:4900 CHERRY CREEK SOUTH DR
Practice Address - Street 2:SUITE B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2283
Practice Address - Country:US
Practice Address - Phone:303-300-0220
Practice Address - Fax:303-300-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
493818Medicare PIN