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General NPI Number Information
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NPI Number | 1841535176
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Entity Type | Organization
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Legal Business Name | RAFAEL LAO, M.D.
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 700 WILLOW ST SUITE 100
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City | VINCENNES
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State | IN
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Zip | 47591-1028
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Country | US
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Telephone | 812-882-6124
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Fax | 812-882-8620
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Provider Business Mailing Address
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Address Line | PO BOX 232
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City | VINCENNES
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State | IN
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Zip | 47591-0232
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Country | US
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Telephone | 812-882-6124
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Fax | 812-882-8620
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAFAEL LAO
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Credential | M.D.
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Telephone | 812-882-6124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 10142614A
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License Number State | IN
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