Provider Demographics
NPI:1407910425
Name:LAUER, KATHERYN J (MD)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:J
Last Name:LAUER
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 9787
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0787
Mailing Address - Country:US
Mailing Address - Phone:509-574-3600
Mailing Address - Fax:509-574-3654
Practice Address - Street 1:302 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3521
Practice Address - Country:US
Practice Address - Phone:509-574-3600
Practice Address - Fax:509-574-3654
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60749471207Q00000X, 207QH0002X
MN51613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407910425Medicaid
MN1407910425Medicaid
WA2083894Medicaid