Individual
LAURA G. SPORL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4215 49TH AVE NE, TACOMA, WA 98422-2421
(253) 459-7699
(253) 459-7675
Mailing address
4215 49TH AVE NE, TACOMA, WA 98422-2421
(253) 459-7699
(253) 459-7675
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
10073R
LA
207V00000X
Obstetrics & Gynecology Physician
Primary
MD00047209
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1686450
—
LA
01
—
3374SP
BLUE SHIELD VM
WA
01
—
5812274
AETNA SPECIALIST PIN VM
WA
05
—
8481152
—
WA
01
—
P00394683
RAILROAD MC # VM
WA
Enumeration date
07/24/2006
Last updated
12/21/2011
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