Provider Demographics
NPI:1053326876
Name:LENDERMON, LAURA N (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:N
Last Name:LENDERMON
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:PO BOX 770929
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:9950 CROOKED CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-850-5756
Practice Address - Fax:901-850-5911
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29507207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
557272OtherVESTICA
TN3857889Medicaid
TN4047417OtherBCBS
MS09828049Medicaid
010066266OtherRAIL ROAD MEDICARE
557272OtherVESTICA
TN3857889Medicare PIN