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NPI Code Detail

MEDICARE: LAURA ELLEN REGA MD

MEDICARE: LAURA ELLEN REGA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician23619IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336142637
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ELLEN REGA MD
Provider Business Mailing Address
First Line : 9255 ATLANTIC DR SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-8950
Country : US
Telephone Number : 319-396-2000
Fax Number : 319-396-5567
Provider Business Practice Location Address
First Line : 9255 ATLANTIC DR SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-8950
Country : US
Telephone Number : 319-396-2000
Fax Number : 319-396-5567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 05/17/2012

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Directions to “ LAURA ELLEN REGA MD” Practice Location

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