Provider Demographics
NPI:1083607014
Name:DAVIS, LAURA J (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 NE 20TH AVE
Mailing Address - Street 2:#200
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6418
Mailing Address - Country:US
Mailing Address - Phone:360-695-8553
Mailing Address - Fax:360-737-3713
Practice Address - Street 1:14508 NE 20TH AVE
Practice Address - Street 2:#200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6418
Practice Address - Country:US
Practice Address - Phone:360-695-8553
Practice Address - Fax:360-737-3713
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-02-29
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
WAMD00043457207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854033Medicare PIN
WAH61167Medicare UPIN