Provider Demographics
NPI:1356346217
Name:ANDERSON COWELL, LAUREL RENE (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:RENE
Last Name:ANDERSON COWELL
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 1:2415 NE 134TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3029
Mailing Address - Country:US
Mailing Address - Phone:503-294-6171
Mailing Address - Fax:
Practice Address - Street 1:9701 SW BARNES RD STE 130
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6688
Practice Address - Country:US
Practice Address - Phone:503-297-4779
Practice Address - Fax:503-294-1868
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21106207K00000X, 207KI0005X, 207KA0200X
WAMD00036612207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287109Medicaid
WAG8860800Medicare PIN
E99908Medicare UPIN
ORR103909Medicare PIN