Provider Demographics
NPI:1114919222
Name:DAVIS LUARDE, LAURA A (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:DAVIS LUARDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:2535 HALE ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1856
Practice Address - Country:US
Practice Address - Phone:440-934-8810
Practice Address - Fax:440-934-8811
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00140594OtherRR MEDICARE
OH2488062Medicaid
OHI14151Medicare UPIN
OH4140523Medicare PIN
OH2488062Medicaid