Provider Demographics
NPI:1619025962
Name:PERRY, LAURA CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CHRISTINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 DES MOINES MEMORIAL DR STE 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2287
Mailing Address - Country:US
Mailing Address - Phone:206-243-7818
Mailing Address - Fax:206-243-0419
Practice Address - Street 1:12610 DES MOINES MEMORIAL DR STE 206
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-2287
Practice Address - Country:US
Practice Address - Phone:206-243-7818
Practice Address - Fax:206-243-0419
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE20233Medicare UPIN