Healthcare Provider Details

I. General information

NPI: 1104098110
Provider Name (Legal Business Name): LAURA TERESA WITHERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA TERESA GIDEON WITHERS M.D.

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR DDEPARTMENT OF FAMILT MEDICINE
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

3500 S. SCOTT BLVD 12B
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-7060
  • Fax:
Mailing address:
  • Phone: 917-650-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number002800501
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2025045730
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number602330543
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME102332
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number602330543
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: