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1437171238

NPI Code Detail

MEDICARE: LAURA G. SPORL MD

MEDICARE: LAURA G. SPORL 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
1	207RC0000X	Cardiovascular Disease Physician	10073R	LA
2	207V00000X	Obstetrics & Gynecology Physician	MD00047209	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3374SP	OTHER	WA	BLUE SHIELD VM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5812274	OTHER	WA	AETNA SPECIALIST PIN VM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P00394683	OTHER	WA	RAILROAD MC # VM

General Provider Information

NPI Number	:	1437171238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA G. SPORL MD

Provider Business Mailing Address
First Line	:	4215 49TH AVE NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-2421
Country	:	US
Telephone Number	:	253-459-7699
Fax Number	:	253-459-7675

Provider Business Practice Location Address
First Line	:	4215 49TH AVE NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-2421
Country	:	US
Telephone Number	:	253-459-7699
Fax Number	:	253-459-7675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/21/2011

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Directions to “ LAURA G. SPORL MD” Practice Location

Language	Start Address	Practice Location

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