Healthcare Provider Details

I. General information

NPI: 1659680452
Provider Name (Legal Business Name): AUGUSTINE W. LAU M.D., P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W 24TH ST
YUMA AZ
85364-6233
US

IV. Provider business mailing address

1320 W 24TH ST
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 TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34390
License Number StateAZ

VIII. Authorized Official

Name: AUGUSTINE W LAU
Title or Position: DOCTOR
Credential: M.D.
Phone: 520-888-5278