Provider Demographics
NPI:1326208752
Name:GRATTON, LAURA DANIELLE (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DANIELLE
Last Name:GRATTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NW BEAVER ST. STE 101
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754
Mailing Address - Country:US
Mailing Address - Phone:541-447-0707
Mailing Address - Fax:541-447-0708
Practice Address - Street 1:975 NW BEAVER STREET
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-447-0707
Practice Address - Fax:541-447-0708
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4002207Q00000X
ORDO154358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine