Provider Demographics
NPI:1003896051
Name:LAU, AUGUSTINE W (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:W
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2375 S. RIDGEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-317-2518
Mailing Address - Fax:928-317-1811
Practice Address - Street 1:2375 S. RIDGEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-317-2518
Practice Address - Fax:928-317-1811
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34390207RH0003X, 207R00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ169051Medicare PIN