Provider Demographics
NPI:1720069529
Name:GEARHART, LAUREN MARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARLENE
Last Name:GEARHART
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 1:10673 SW EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5512
Mailing Address - Country:US
Mailing Address - Phone:503-682-3392
Mailing Address - Fax:
Practice Address - Street 1:16463 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4207
Practice Address - Country:US
Practice Address - Phone:503-635-6256
Practice Address - Fax:503-636-9064
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine