Provider Demographics
NPI:1568783306
Name:GEPHART, LAURA FAYE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:FAYE
Last Name:GEPHART
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 1:311 W 24TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2668
Mailing Address - Country:US
Mailing Address - Phone:814-452-4214
Mailing Address - Fax:814-459-7823
Practice Address - Street 1:311 W 24TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2668
Practice Address - Country:US
Practice Address - Phone:814-452-4214
Practice Address - Fax:814-459-7823
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469792207V00000X, 2088F0040X
TXQ0261207V00000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08HJ61101OtherBCBS
TX33987703Medicaid