Healthcare Provider Details

I. General information

NPI: 1134247331
Provider Name (Legal Business Name): LAURA MICHELLE LAUER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST NMRTC JACKSONVILLE EMERGENCY DEPARTMENT
JACKSONVILLE FL
32214-6101
US

IV. Provider business mailing address

2080 CHILD ST NMRTC JACKSONVILLE EMERGENCY DEPARTMENT
JACKSONVILLE FL
32214-6101
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7345
  • Fax:
Mailing address:
  • Phone: 904-542-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102202265
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102202265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: