Provider Demographics
NPI:1316915267
Name:REAGER, LAUREN L (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:L
Last Name:REAGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:990W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2103
Mailing Address - Country:US
Mailing Address - Phone:310-829-4484
Mailing Address - Fax:310-829-4481
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:990W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2103
Practice Address - Country:US
Practice Address - Phone:310-829-4484
Practice Address - Fax:310-829-4481
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21656207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A22712Medicare UPIN
CAW8759Medicare ID - Type Unspecified