Individual
LAURI M TADLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14030 NE 24TH ST, SUITE 202, BELLEVUE, WA 98007
(425) 454-1104
(425) 454-1290
Mailing address
14030 NE 24TH ST, SUITE 202, BELLEVUE, WA 98007
(425) 454-1104
(425) 454-1290
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD00021891
WA
207NP0225X
Pediatric Dermatology Physician
MD00021891
WA
207NS0135X
Procedural Dermatology Physician
MD00021891
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070007061
RAILROAD MEDICARE
WA
05
—
1087154
—
WA
01
—
4120050
AETNA
—
05
—
7080237
—
WA
01
—
CN9262
RAILROAD MEDICARE
WA
01
—
TA0069
REGENCE
—
Enumeration date
09/07/2006
Last updated
06/28/2010
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