Provider Demographics
NPI:1932644002
Name:SANFORD, LAURA ASHLEY (DO)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ASHLEY
Last Name:SANFORD
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:205 DALLAS STREET
Mailing Address - Street 2:TALIHINA COMMUNITY CLINIC
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571
Mailing Address - Country:US
Mailing Address - Phone:918-567-3636
Mailing Address - Fax:918-567-3635
Practice Address - Street 1:205 DALLAS STREET
Practice Address - Street 2:TALIHINA COMMUNITY CLINIC
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571
Practice Address - Country:US
Practice Address - Phone:918-567-3636
Practice Address - Fax:918-567-3635
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2019-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK6247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200470580AMedicaid