Healthcare Provider Details

I. General information

NPI: 1942728365
Provider Name (Legal Business Name): LAWRENCE S. WILNER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE J
CASTLE PINES CO
80108-9454
US

IV. Provider business mailing address

7280 LAGAE RD STE J
CASTLE PINES CO
80108-9454
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax: 303-914-6491
Mailing address:
  • Phone: 303-814-0505
  • Fax: 303-914-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0032016
License Number StateCO

VIII. Authorized Official

Name: LAWRENCE S. WILNER
Title or Position: DO/OWNER
Credential: DO
Phone: 303-814-0505