MEDICARE: LAURA SANDRA WILLINGMYRE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	43889	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699856534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA SANDRA WILLINGMYRE MD

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 N WYATT DR STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2120
Country	:	US
Telephone Number	:	520-616-4948
Fax Number	:	520-616-4958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/27/2025

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