Individual
LAURANCE WALTER CHOATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1813 W HARVARD AVE STE 201, ROSEBURG, OR 97471-2754
(541) 440-6390
(541) 440-6392
Mailing address
1813 W HARVARD AVE STE 201, ROSEBURG, OR 97471-2754
(541) 440-6390
(541) 440-6392
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36137
IA
207Q00000X
Family Medicine Physician
Primary
MD158348
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0460477
—
IA
01
—
39425
WELLMARK BC/BS OF IA
IA
Enumeration date
02/07/2006
Last updated
03/13/2013
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