Provider Demographics
NPI:1548526114
Name:GERAGHTY, LAUREL NAVERSEN (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:NAVERSEN
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 SISKIYOU BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8131
Mailing Address - Country:US
Mailing Address - Phone:541-773-3636
Mailing Address - Fax:541-773-4643
Practice Address - Street 1:2959 SISKIYOU BLVD
Practice Address - Street 2:STE B
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8131
Practice Address - Country:US
Practice Address - Phone:541-773-3636
Practice Address - Fax:541-773-4643
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD176494207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program