Healthcare Provider Details

I. General information

NPI: 1205816436
Provider Name (Legal Business Name): LAURA L PLACE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 GAUSE BLVD E
SLIDELL LA
70461-4141
US

IV. Provider business mailing address

1514 JEFFERSON HWY ATTN: CREDENTIALS (CMC)
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax: 985-639-3778
Mailing address:
  • Phone: 623-856-4396
  • Fax: 623-856-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.022504
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: