MEDICARE: LAURA MCGRAW L.AC

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	171100000X	Acupuncturist	00852	OR

General Provider Information

NPI Number	:	1902979388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCGRAW L.AC

Provider Business Mailing Address
First Line	:	3430 SE BELMONT ST # 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4247
Country	:	US
Telephone Number	:	503-232-7362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 SE BELMONT ST # 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4247
Country	:	US
Telephone Number	:	503-232-7362
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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