Provider Demographics
NPI:1801048772
Name:CLAUDIA B. WYRICK, M.D., PROF. LLC
Entity type:Organization
Organization Name:CLAUDIA B. WYRICK, M.D., PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-484-0000
Mailing Address - Street 1:PO BOX 280406
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-0406
Mailing Address - Country:US
Mailing Address - Phone:719-484-0000
Mailing Address - Fax:
Practice Address - Street 1:13705 W 82ND AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1807
Practice Address - Country:US
Practice Address - Phone:719-484-0000
Practice Address - Fax:719-487-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29688208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35138530Medicaid
CO35138530Medicaid