Provider Demographics
NPI:1437244688
Name:ANDERS, LAURA A (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:ANDERS
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 1:709 W 8TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4125
Mailing Address - Country:US
Mailing Address - Phone:307-682-3333
Mailing Address - Fax:307-682-6723
Practice Address - Street 1:709 W 8TH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4125
Practice Address - Country:US
Practice Address - Phone:307-682-3333
Practice Address - Fax:307-682-6723
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5430A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY08012411OtherRAILROAD MEDICARE
WY08012411OtherRAILROAD MEDICARE
BA2759225OtherDEA
WY307438Medicare ID - Type Unspecified