Provider Demographics
NPI:1073872867
Name:SANDEFUR, LAUREN LEE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEE
Last Name:SANDEFUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LEE BETTY
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:901 E 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1186
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3971
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG168320208000000X
NV17521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics