Provider Demographics
NPI:1629333414
Name:WEYL, LARA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:ANN
Last Name:WEYL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:GARRITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 MAY ST
Practice Address - Street 2:STE 202
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031
Practice Address - Country:US
Practice Address - Phone:541-387-8940
Practice Address - Fax:541-387-8908
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138218207V00000X
ORDO175935207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500711206Medicaid
OR500711206Medicaid