Provider Demographics
NPI:1356455851
Name:OSTEZAN, LAURA BEGGIN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BEGGIN
Last Name:OSTEZAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:BEGGIN
Other - Last Name:DAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10479 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521
Mailing Address - Country:US
Mailing Address - Phone:775-850-8600
Mailing Address - Fax:775-850-8665
Practice Address - Street 1:10479 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-850-8600
Practice Address - Fax:775-850-8665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8651207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG79303Medicare UPIN
NV38844Medicare ID - Type UnspecifiedMEDICARE NUMBER