Provider Demographics
NPI:1093010126
Name:MCGOVERN, LAURA JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:KUCINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:941-202-5342
Practice Address - Street 1:1812 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5535
Practice Address - Country:US
Practice Address - Phone:727-943-3355
Practice Address - Fax:877-902-4052
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine