MEDICARE: LAURA L DIPUMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD0000026903	TN

General Provider Information

NPI Number	:	1447568241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L DIPUMA MD

Provider Business Mailing Address
First Line	:	569 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3911
Country	:	US
Telephone Number	:	731-423-0975
Fax Number	:	731-424-5061

Provider Business Practice Location Address
First Line	:	2027 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3576
Country	:	US
Telephone Number	:	731-668-6882
Fax Number	:	731-668-6882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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