Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 107741 | MO |
NPI | 1114000957 |
---|---|
Provider Name | Dr. Laura Ann O'gorman |
First Address | Columbia, MO 65205-4003 |
Second Address | Columbia, MO 65201-5844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11060392 | CAQHPROVIDER ID (01) | |
17315 | ANTHEM BCBS PIN (01) | |
17676 | HEALTHCARE USA PIN (01) | |
271875 | HEALTHLINK PIN (01) | |
H27033 | (02) |