Provider Demographics
NPI:1740269307
Name:MAPLE, LAURA D (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:D
Last Name:MAPLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:6500 HOSPITAL DRIVE
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-629-3512
Mailing Address - Fax:573-629-3555
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3512
Practice Address - Fax:573-629-3555
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005015443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207357708Medicaid
MO207357708Medicaid
MO932393772Medicare PIN