Provider Demographics
NPI:1043278732
Name:GOLL, LAURENE E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENE
Middle Name:E
Last Name:GOLL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:SUITE A-100 - ARIZONA COMMUNITY PHYSICIAN PC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:3190 N SWAN ROAD
Practice Address - Street 2:CAMP LOWELL MEDICAL SPECIALISTS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-547-9700
Practice Address - Fax:520-547-9719
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-05-08
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Provider Licenses
StateLicense IDTaxonomies
AZ21124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62514Medicare UPIN