Provider Demographics
NPI:1245205582
Name:SMIRICKY, LAURA A (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:SMIRICKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2620 EAST BARNETT RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-789-5250
Mailing Address - Fax:541-789-5538
Practice Address - Street 1:500 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-472-7000
Practice Address - Fax:312-829-2024
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036097740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097740Medicaid
IL036097740Medicaid