Provider Demographics
NPI:1073809695
Name:ROE, LAURA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:ROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:FINCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5400 W SIENNA LN
Mailing Address - Street 2:APT 1203
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7871
Mailing Address - Country:US
Mailing Address - Phone:765-438-7328
Mailing Address - Fax:
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:#5607
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine