Healthcare Provider Details

I. General information

NPI: 1144562554
Provider Name (Legal Business Name): LAURA ELIZABETH ROAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE # T2M4
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1542 TULANE AVE # T2M4
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-5600
  • Fax: 504-568-7884
Mailing address:
  • Phone: 504-962-6110
  • Fax: 504-568-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number306340
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number306340
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: