Provider Demographics
NPI:1326080508
Name:OUELLETTE, LAURA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:OUELLETTE
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 1:1700 GEARY ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6842
Mailing Address - Country:US
Mailing Address - Phone:541-812-5570
Mailing Address - Fax:541-812-5699
Practice Address - Street 1:1700 GEARY ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6842
Practice Address - Country:US
Practice Address - Phone:541-812-5570
Practice Address - Fax:541-812-5699
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
015388000OtherBCBS
044636OtherMARION POLK CHP
WA8398588Medicaid
0187364OtherWA L&I
8938593OtherWA CRIME VICTIMS
A03419OtherPROVIDENCE
A03419OtherGROUP HEALTH
OR044636Medicaid
119651Medicare ID - Type Unspecified
WA8398588Medicaid