Healthcare Provider Details

I. General information

NPI: 1689622755
Provider Name (Legal Business Name): LAURA ANNE HOTCHKISS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANNE GALLUP HOTCHKISS

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23610 E BROADWAY AVE
LIBERTY LAKE WA
99019-9641
US

IV. Provider business mailing address

22100 BOTHELL EVERETT HWY
BOTHELL WA
98021-8431
US

V. Phone/Fax

Practice location:
  • Phone: 855-292-1401
  • Fax: 866-396-8340
Mailing address:
  • Phone: 208-413-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101243452
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTM00257
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberV4793
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00045456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: