Provider Demographics
NPI:1801020847
Name:DWYER, LAURA VERKEST (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:VERKEST
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6880
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6880
Mailing Address - Country:US
Mailing Address - Phone:505-395-2288
Mailing Address - Fax:505-983-8135
Practice Address - Street 1:649 HARKLE RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4765
Practice Address - Country:US
Practice Address - Phone:505-989-8200
Practice Address - Fax:505-216-9067
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2017-0868207Q00000X
LA204949207Q00000X
IL036.130823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty