Provider Demographics
NPI:1740277557
Name:ADAMS, LAURA L (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4200 JENNY LIND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7660
Mailing Address - Country:US
Mailing Address - Phone:479-484-1010
Mailing Address - Fax:479-484-9595
Practice Address - Street 1:4200 JENNY LIND RD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7660
Practice Address - Country:US
Practice Address - Phone:479-484-1010
Practice Address - Fax:479-484-9595
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE3144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200004970AMedicaid
AR149052001Medicaid
ARH80806Medicare UPIN
AR149052001Medicaid