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NPI Code Detail

MEDICARE: DR. LAURA A TAVERNIER MD

MEDICARE: DR. LAURA A TAVERNIER 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
1207Q00000XFamily Medicine PhysicianG077131CA
2207P00000XEmergency Medicine Physician31007TN

General Provider Information

NPI Number : 1932101953
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA A TAVERNIER MD
Provider Business Mailing Address
First Line : 4430 MISSOURI AVE
Second Line :
City : FORT LEONARD WOOD
State : MO
Zip : 65473-9098
Country : US
Telephone Number : 573-596-0417
Fax Number :
Provider Business Practice Location Address
First Line : 4430 MISSOURI AVE
Second Line :
City : FORT LEONARD WOOD
State : MO
Zip : 65473-9098
Country : US
Telephone Number : 573-596-0417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/10/2023

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