Healthcare Provider Details

I. General information

NPI: 1114995131
Provider Name (Legal Business Name): LAURA MAYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11475 ROBINSON DR NW
COON RAPIDS MN
55433-3746
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-9000
  • Fax: 763-587-9130
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number46476
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: