Healthcare Provider Details

I. General information

NPI: 1245301670
Provider Name (Legal Business Name): LAURA C SMOTHERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 EAST SECOND STREET
CASPER WY
82601
US

IV. Provider business mailing address

1125 EAST SECOND STREET
CASPER WY
82601
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-4225
  • Fax: 307-577-4229
Mailing address:
  • Phone: 307-577-4225
  • Fax: 307-577-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6581A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: