Provider Demographics
NPI:1912990367
Name:PERRIN, LAURIE SUE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:SUE
Last Name:PERRIN
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 1:1100 N SAN FRANCISCO ST
Mailing Address - Street 2:STE B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3260
Mailing Address - Country:US
Mailing Address - Phone:928-779-7852
Mailing Address - Fax:928-774-0508
Practice Address - Street 1:1100 N SAN FRANCISCO ST
Practice Address - Street 2:STE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3260
Practice Address - Country:US
Practice Address - Phone:928-779-7852
Practice Address - Fax:928-774-0508
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31323207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ774382Medicaid
AZ774382Medicaid
AZ85476Medicare ID - Type Unspecified