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NPI Code Detail

MEDICARE: LAURA MICHELLE DART M.D.

MEDICARE: LAURA MICHELLE DART M.D.
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
1208000000XPediatrics PhysicianMD187643OR

General Provider Information

NPI Number : 1780079350
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA MICHELLE DART M.D.
Provider Business Mailing Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3011
Country : US
Telephone Number : 503-494-8211
Fax Number :
Provider Business Practice Location Address
First Line : 2800 N VANCOUVER AVE STE 165
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1644
Country : US
Telephone Number : 503-413-2902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2015
Last Update Date : 01/14/2019

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Directions to “ LAURA MICHELLE DART M.D.” Practice Location

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