Healthcare Provider Details

I. General information

NPI: 1770788085
Provider Name (Legal Business Name): GREGORY PETER FORLENZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 AURORA CT MS #A140
AURORA CO
80045-2536
US

IV. Provider business mailing address

1775 AURORA CT MS #A140
AURORA CO
80045-2536
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2323
  • Fax: 303-724-6779
Mailing address:
  • Phone: 303-724-2323
  • Fax: 303-724-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number56157
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number67566
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME 109590
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number48738
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: