Provider Demographics
NPI:1346315769
Name:LAURENCE, TED L (PA)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:L
Last Name:LAURENCE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:12750 HIGHWAY 96
Mailing Address - Street 2:LANE 13
Mailing Address - City:CROWLEY
Mailing Address - State:CO
Mailing Address - Zip Code:81034-0001
Mailing Address - Country:US
Mailing Address - Phone:719-267-5071
Mailing Address - Fax:719-267-5079
Practice Address - Street 1:12750 HIGHWAY 96
Practice Address - Street 2:LANE 13
Practice Address - City:CROWLEY
Practice Address - State:CO
Practice Address - Zip Code:81034-0001
Practice Address - Country:US
Practice Address - Phone:719-267-5071
Practice Address - Fax:719-267-5079
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical