Basic Information
| Provider Information | |||||||||
| NPI: | 1548600208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUDERT | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CURRY MEDICAL PRACTICE | ||||||||
| Address2: | 94220 4TH STREET | ||||||||
| City: | GOLD BEACH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412473910 | ||||||||
| FaxNumber: | 5412473109 | ||||||||
| Practice Location | |||||||||
| Address1: | CURRY MEDICAL PRACTICE | ||||||||
| Address2: | 94220 4TH STREET | ||||||||
| City: | GOLD BEACH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412473910 | ||||||||
| FaxNumber: | 5412473109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 11/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD182805 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD182805 | 01 | OR | OREGON MEDICAL BOARD | OTHER | 500713549 | 05 | OR | MEDICAID | 1487696985 | 01 | OR | CURRY GENERAL HOSPITAL NPI | OTHER | 1346486818 | 01 | OR | CURRY MEDICAL PRACTICE | OTHER |