Provider Demographics
NPI:1376636134
Name:LAU, YOYEN (DO)
Entity Type:Individual
Prefix:
First Name:YOYEN
Middle Name:
Last Name:LAU
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:PO BOX 366
Mailing Address - Street 2:280 INDUSTRIAL BLVD
Mailing Address - City:LEESBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35983
Mailing Address - Country:US
Mailing Address - Phone:256-526-6926
Mailing Address - Fax:
Practice Address - Street 1:280 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:AL
Practice Address - Zip Code:35983
Practice Address - Country:US
Practice Address - Phone:256-526-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000098541Medicare ID - Type Unspecified
ALG27837Medicare UPIN