Healthcare Provider Details

I. General information

NPI: 1053578856
Provider Name (Legal Business Name): JEAN YVES LAURORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

IV. Provider business mailing address

1010 W KENSINGTON CIR
FREDERICKSBURG VA
22401-8003
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-3839
  • Fax: 877-780-4242
Mailing address:
  • Phone: 347-751-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101243632
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: