Provider Demographics
NPI:1407844046
Name:SELLS, LAURA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:SELLS
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 CANYONS RESORT DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6546
Practice Address - Country:US
Practice Address - Phone:435-615-2235
Practice Address - Fax:435-645-7768
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6185229-1205208000000X
OH350698642080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247530Medicaid
KY64027154Medicaid
WV1805700000Medicaid
KY64027154Medicaid
H31748Medicare UPIN