Provider Demographics
NPI:1548378946
Name:CARR, LAURA GAIL (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GAIL
Last Name:CARR
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 LEESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8702
Mailing Address - Country:US
Mailing Address - Phone:859-255-6812
Mailing Address - Fax:859-253-5833
Practice Address - Street 1:3301 LEESTOWN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8702
Practice Address - Country:US
Practice Address - Phone:859-255-6812
Practice Address - Fax:859-253-5833
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY398672083P0500X
IN01064180A2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY09052OtherMEDICARE
KY06929OtherMEDICARE
KY09052OtherMEDICARE
IN815150AAAAMedicare PIN
KY06929OtherMEDICARE
KY06930Medicare ID - Type Unspecified