Provider Demographics
NPI:1336501170
Name:POLING, LAUREN KIMBERLY (DO)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KIMBERLY
Last Name:POLING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:KIMBERLY
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4319 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3530
Mailing Address - Country:US
Mailing Address - Phone:602-888-0448
Mailing Address - Fax:
Practice Address - Street 1:4319 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3530
Practice Address - Country:US
Practice Address - Phone:602-888-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine