Provider Demographics
NPI:1760038632
Name:LAURY, MADELEINE M (MD)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:M
Last Name:LAURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:MEI-LING
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E STE 2A200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-213-2095
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E STE 2A200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2909
Practice Address - Country:US
Practice Address - Phone:801-213-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14172269-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology