Provider Demographics
NPI:1972591196
Name:PENNY, LARA (MD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST # MC1914
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-602-4000
Mailing Address - Fax:303-602-4064
Practice Address - Street 1:777 BANNOCK ST # MC1914
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-602-4000
Practice Address - Fax:303-602-4064
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22782346Medicaid
CO22782346Medicaid
C418268Medicare ID - Type Unspecified