Healthcare Provider Details

I. General information

NPI: 1013414077
Provider Name (Legal Business Name): LAURAN WIRFS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LEETSDALE DR
DENVER CO
80246-1438
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-629-5293
  • Fax:
Mailing address:
  • Phone: 303-303-4364
  • Fax: 303-602-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125071893
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0065742
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: