Provider Demographics
NPI:1982961728
Name:DAILY, LAURA REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:REBECCA
Last Name:DAILY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:REBECCA
Other - Last Name:DAILY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:501 MARSHALL ST STE G07
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-968-3238
Practice Address - Fax:601-968-3237
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-90608207VG0400X
TN54021207VG0400X
MS24393207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07109261Medicaid
AR214950001Medicaid
TNQ022571Medicaid
AR214950001Medicaid
TN103I167852Medicare PIN