Provider Demographics
NPI:1932136330
Name:LAUGHLIN-GAINES, TAMARA ANN (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:LAUGHLIN-GAINES
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 1:516 E. NIZHONI BLVD
Mailing Address - Street 2:BOX 1337
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1000
Mailing Address - Fax:505-726-8740
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:BOX 1337
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-726-8740
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62951572Medicaid
AZ762410Medicaid
TX8HBG18Medicare ID - Type UnspecifiedHSZ002
NM62951572Medicaid
H23475Medicare UPIN
TX8HC948Medicare ID - Type UnspecifiedHSZ005
TX8HBG20Medicare ID - Type UnspecifiedHSZ006
AZ762410Medicaid
TX8HBX78Medicare ID - Type UnspecifiedHSZ197