Provider Demographics
NPI:1831282821
Name:ANDERTON, LAURIE M (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:M
Last Name:ANDERTON
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 1:12005 MERIDIAN E STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3423
Mailing Address - Country:US
Mailing Address - Phone:253-215-1095
Mailing Address - Fax:253-215-1096
Practice Address - Street 1:12005 MERIDIAN E STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3423
Practice Address - Country:US
Practice Address - Phone:253-215-1095
Practice Address - Fax:253-215-1096
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA33567207P00000X
WAMD00033567207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020173Medicaid
WA8188625Medicaid
217117016Medicare ID - Type Unspecified