Provider Demographics
NPI:1356686646
Name:MARK LAURSEN, MD
Entity Type:Organization
Organization Name:MARK LAURSEN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-282-0774
Mailing Address - Street 1:10 VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 VIEW DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5544
Practice Address - Country:US
Practice Address - Phone:928-282-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty
No132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty