Provider Demographics
NPI:1982670006
Name:DAVIES, LAURA H (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:DAVIES
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 155
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2956
Practice Address - Country:US
Practice Address - Phone:503-215-6819
Practice Address - Fax:503-215-6492
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23818207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232910Medicaid
P00745114OtherRR MEDICARE
OR142615Medicare PIN
OR119955Medicare PIN
OR232910Medicaid
ORR147415Medicare PIN