Healthcare Provider Details

I. General information

NPI: 1407112741
Provider Name (Legal Business Name): LAURA MARIE FLUKE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENTARA CIR STE 202
WILLIAMSBURG VA
23188-5727
US

IV. Provider business mailing address

2200 SANTA MONICA BLVD
SANTA MONICA CA
90404-2312
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-9850
  • Fax:
Mailing address:
  • Phone: 310-449-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0102203516
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: