Provider Demographics
NPI:1942269790
Name:CONWAY, LAURIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:J
Last Name:CONWAY
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 1:209 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-5359
Mailing Address - Country:US
Mailing Address - Phone:785-863-3417
Mailing Address - Fax:
Practice Address - Street 1:209 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-5359
Practice Address - Country:US
Practice Address - Phone:785-863-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28085207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100396450BMedicaid
KS100396450BMedicaid
067239Medicare ID - Type Unspecified