Basic Information
| Provider Information | |||||||||
| NPI: | 1336126184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAYNOR | ||||||||
| FirstName: | LAURENCE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 18133 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 104686150 | 01 | MI | MI MEDICAID | OTHER | 179782001 | 05 | AR | MEDICAID | 300049135 | 01 | CO | RR MCRE RIA | OTHER | 100257090000 | 05 | NE | MEDICAID | 414545970A | 01 | GA | GA MEDICAID | OTHER | 7100227240 | 05 | KY | MEDICAID | 7617666 | 05 | NC | MEDICAID | 01181338 | 05 | CO | MEDICAID | 1336126184 | 05 | IL | MEDICAID | 200424900A | 05 | OK | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 922121 | 01 | AZ | AZ MEDICAID | OTHER | 02555484 | 01 | NY | NY MEDICAID | OTHER | 053216001 | 01 | TX | TX MEDICAID | OTHER | 1336126184 | 05 | WY | MEDICAID | 200410090A | 05 | KS | MEDICAID | 84073331 | 05 | NM | MEDICAID | XPY201227 | 01 | CA | CA MEDICAID | OTHER | 100017792 | 05 | WI | MEDICAID | 300089928 | 01 | CO | RR MCRE MIC | OTHER | 1336126184 | 05 | UT | MEDICAID | 2316265 | 05 | LA | MEDICAID |