Healthcare Provider Details

I. General information

NPI: 1083621189
Provider Name (Legal Business Name): AUBREY ABRAHAM LURIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE OVERTON BROOKS VA MED. CENTER (113)
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

510 E. STONER AVE. (113) OVERTON BROOKS VA MEDICAL CENTER
SHREVEPORT LA
71101-6128
US

V. Phone/Fax

Practice location:
  • Phone: 318-424-6092
  • Fax: 318-424-6093
Mailing address:
  • Phone: 318-424-6092
  • Fax: 318-424-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number07934R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: