Provider Demographics
NPI:1871065896
Name:MATHER, LAURA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MATHER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1450 S DOBSON RD STE A200
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4742
Mailing Address - Country:US
Mailing Address - Phone:480-629-5167
Mailing Address - Fax:480-912-1068
Practice Address - Street 1:9520 W PALM LN STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4403
Practice Address - Country:US
Practice Address - Phone:480-556-0446
Practice Address - Fax:480-556-0447
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2025-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ7260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant