Provider Demographics
NPI:1023092152
Name:YOCOM, LAUREL B (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:B
Last Name:YOCOM
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 1:1348 NE CUSHING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3876
Mailing Address - Country:US
Mailing Address - Phone:541-382-7696
Mailing Address - Fax:
Practice Address - Street 1:1348 NE CUSHING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3876
Practice Address - Country:US
Practice Address - Phone:541-382-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 15390207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR053843Medicaid
OR053843Medicaid
ORR00WBGLTDMedicare PIN