Basic Information
| Provider Information | |||||||||
| NPI: | 1508842451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FENTON | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | Z. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 110429 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800420429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034937000 | ||||||||
| FaxNumber: | 3034937202 | ||||||||
| Practice Location | |||||||||
| Address1: | 13123 E 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800457106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207771234 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 11/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 36952 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085P0229X | DR.0036952 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
ID Information
| ID | Type | State | Issuer | Description | 667418761A | 05 | GA | MEDICAID | 60037750 | 05 | NM | MEDICAID | 01369529 | 05 | CO | MEDICAID | 100364650B | 05 | KS | MEDICAID | 525115 | 05 | AZ | MEDICAID | P00123278 | 01 | CO | RR MCRE MIC | OTHER | 1508842451 | 05 | MT | MEDICAID | 805662900 | 05 | ID | MEDICAID | XPY203764 | 05 | CA | MEDICAID | 104686104 | 05 | MI | MEDICAID | P00123269 | 01 | CO | RR MCRE DIA | OTHER | 1546820 | 05 | IA | MEDICAID | 060974502 | 05 | TX | MEDICAID | 100020300A | 05 | OK | MEDICAID | 114854100 | 05 | WY | MEDICAID | P00123276 | 01 | CO | RR MCRE RIA | OTHER |