Provider Demographics
NPI:1396319067
Name:MILLER-GIFFORD, LAUREN N (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:MILLER-GIFFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2587
Mailing Address - Country:US
Mailing Address - Phone:620-342-2900
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2589
Practice Address - Country:US
Practice Address - Phone:620-343-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS05-49906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program