Provider Demographics
NPI:1336142637
Name:REGA, LAURA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:REGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9255 ATLANTIC DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-8950
Mailing Address - Country:US
Mailing Address - Phone:319-396-2000
Mailing Address - Fax:319-396-5567
Practice Address - Street 1:9255 ATLANTIC DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-8950
Practice Address - Country:US
Practice Address - Phone:319-396-2000
Practice Address - Fax:319-396-5567
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1336142637Medicaid
IA0062935Medicaid
IA0062935Medicaid
IA010036881Medicare PIN
IA0363070001Medicare PIN
IA1336142637Medicaid
IA27985Medicare ID - Type Unspecified