Provider Demographics
NPI:1659655207
Name:MCGILL, LAURA (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:MCGILL
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 1:8806 WHITE SAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6406
Mailing Address - Country:US
Mailing Address - Phone:330-573-7019
Mailing Address - Fax:
Practice Address - Street 1:8806 WHITE SAGE LOOP
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6406
Practice Address - Country:US
Practice Address - Phone:330-573-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2728207Q00000X
FLOS12027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine