=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881760106
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA CHRISTINE ANDERSON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 12/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4900 CHERRY CREEK SOUTH DR SUITE B
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80246-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-300-0220
-----------------------------------------------------
Fax | 303-300-9612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 S CHERRY ST STE 420
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80246-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-300-0220
-----------------------------------------------------
Fax | 303-300-9612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 37421
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------