Healthcare Provider Details

I. General information

NPI: 1477449148
Provider Name (Legal Business Name): LAUREN GANN MD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-1606
  • Fax:
Mailing address:
  • Phone: 573-882-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2026014095
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: