MEDICARE: DR. LAUREN MARLENE GEARHART 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	16077	OR

General Provider Information

NPI Number	:	1720069529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN MARLENE GEARHART MD

Provider Business Mailing Address
First Line	:	10673 SW EDGEWOOD CT
Second Line	:
City	:	WILSONVILLE
State	:	OR
Zip	:	97070-5512
Country	:	US
Telephone Number	:	503-682-3392
Fax Number	:

Provider Business Practice Location Address
First Line	:	16463 BOONES FERRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4207
Country	:	US
Telephone Number	:	503-635-6256
Fax Number	:	503-636-9064

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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