MEDICARE: DR. LAURA ANN DUREN M.D.

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	207R00000X	Internal Medicine Physician	ME114313	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1689918831	OTHER	FL	TRICARE
2	1689918831	OTHER	FL	VHN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	14NS2	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689918831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA ANN DUREN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9671
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32120-9671
Country	:	US
Telephone Number	:	386-676-7130
Fax Number	:	386-676-7125

Provider Business Practice Location Address
First Line	:	740 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4239
Country	:	US
Telephone Number	:	386-763-1000
Fax Number	:	386-763-0507

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

Provider Enumeration Date	:	11/11/2012
Last Update Date	:	02/22/2016

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