Provider Demographics
NPI:1467437806
Name:LAUER, GEORGIA LOIS (PAC)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:LOIS
Last Name:LAUER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 WEST AGENCY ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655
Mailing Address - Country:US
Mailing Address - Phone:319-768-5858
Mailing Address - Fax:
Practice Address - Street 1:1706 WEST AGENCY ROAD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30616OtherBLUE CROSS IOWA
IA09901OtherBCBS
IAI9976002Medicare PIN
IA09901OtherBCBS
IAI9976002Medicare UPIN