Provider Demographics
NPI:1013187764
Name:LAUB, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:LAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:591 REDWOOD HWY
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-6001
Mailing Address - Country:US
Mailing Address - Phone:415-381-6661
Mailing Address - Fax:415-789-9882
Practice Address - Street 1:591 REDWOOD HWY
Practice Address - Street 2:SUITE 2210
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-6001
Practice Address - Country:US
Practice Address - Phone:415-381-6661
Practice Address - Fax:415-789-9882
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58416207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G584160Medicare PIN
A53403Medicare UPIN