Provider Demographics
NPI:1922107986
Name:JACIMORE, LAURA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:JACIMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:105 MONABREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4369
Mailing Address - Country:US
Mailing Address - Phone:866-556-1620
Mailing Address - Fax:252-451-3090
Practice Address - Street 1:2450 CURTIS ELLIS DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2237
Practice Address - Country:US
Practice Address - Phone:252-443-8947
Practice Address - Fax:252-451-3090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3000492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891358HMedicaid
NCG21511Medicare UPIN
NC2021609AMedicare PIN