Provider Demographics
NPI:1588950117
Name:HIRL, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HIRL
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 1:1271 8TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2650
Mailing Address - Country:US
Mailing Address - Phone:515-224-4993
Mailing Address - Fax:
Practice Address - Street 1:1271 8TH ST
Practice Address - Street 2:STE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2650
Practice Address - Country:US
Practice Address - Phone:515-224-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-41546208000000X
IAR-9185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588950117Medicaid
IAP01364299OtherRR MEDICARE
IAP01364299OtherRR MEDICARE