Provider Demographics
NPI:1184607152
Name:MARTIN, LAURA ANN (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2360 E PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5356
Mailing Address - Country:US
Mailing Address - Phone:307-778-7322
Mailing Address - Fax:307-778-7531
Practice Address - Street 1:5050 POWDERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4800
Practice Address - Country:US
Practice Address - Phone:307-772-8226
Practice Address - Fax:307-634-1271
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY5157A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104601200Medicaid
WY222LB92OtherSUBSTANCE CONTROL
WY5157AOtherSTATE LICENSE
E43125Medicare UPIN
WY5157AOtherSTATE LICENSE