Basic Information
| Provider Information | |||||||||
| NPI: | 1437252566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10301 GLACIER HWY | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998018565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078744700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 329 BENNET STREET | ||||||||
| Address2: | |||||||||
| City: | WRANGELL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078744700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 02/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5574 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A84007 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD33172 | 05 | AK | MEDICAID |