Ted L. Laurence, PA
Individual provider Active NPI Medical Physician Assistant · Crowley, CO
NPI 1346315769 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1346315769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 543 (CO)
- Practice address
- 12750 Highway 96
Lane 13
Crowley, CO 81034-0001 - Phone
- (719) 267-5071
- Fax
- (719) 267-5079
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 543 | CO | Yes |
Addresses
Primary practice location
12750 Highway 96
Lane 13
Crowley, CO 81034-0001
Mailing address
12750 Highway 96
Lane 13
Crowley, CO 81034-0001
Phone (719) 267-5071
Other providers in Crowley, CO
All providers in Crowley, CO · Medical Physician Assistant in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.