MEDICARE: LAWRENCE GORAB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	17214	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972579639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE GORAB MD

Provider Business Mailing Address
First Line	:	2610 TENDERFOOT HILL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3981
Country	:	US
Telephone Number	:	719-576-4744
Fax Number	:	719-226-8738

Provider Business Practice Location Address
First Line	:	2610 TENDERFOOT HILL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3981
Country	:	US
Telephone Number	:	719-576-4744
Fax Number	:	719-226-8738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	08/08/2011

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