Provider Demographics
NPI:1578555843
Name:STUART, LAUREN H (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:H
Last Name:STUART
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 1:1501 S YALE ST
Mailing Address - Street 2:STE 252
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7304
Mailing Address - Country:US
Mailing Address - Phone:928-774-1811
Mailing Address - Fax:928-774-2006
Practice Address - Street 1:1501 S YALE ST
Practice Address - Street 2:STE 252
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7304
Practice Address - Country:US
Practice Address - Phone:928-774-1811
Practice Address - Fax:928-774-2006
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7340677OtherAETNA
AZ2Z1085OtherHELATH NET
AZ0755870OtherBCBS
AZ853409Medicaid
AZ4861536OtherCIGNA
AZ4861536OtherCIGNA