Healthcare Provider Details

I. General information

NPI: 1003896051
Provider Name (Legal Business Name): AUGUSTINE W LAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 S. RIDGEVIEW DRIVE
YUMA AZ
85364
US

IV. Provider business mailing address

2375 S. RIDGEVIEW DRIVE
YUMA AZ
85364
US

V. Phone/Fax

Practice location:
  • Phone: 928-317-2518
  • Fax: 928-317-1811
Mailing address:
  • Phone: 928-317-2518
  • Fax: 928-317-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34390
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number34390
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number34390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: