Provider Demographics
NPI:1407943046
Name:TOWNE, LAURA ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:TOWNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAN BARTOLA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5767
Mailing Address - Country:US
Mailing Address - Phone:904-823-8823
Mailing Address - Fax:904-808-8587
Practice Address - Street 1:1750 TREE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084
Practice Address - Country:US
Practice Address - Phone:904-824-4005
Practice Address - Fax:904-824-4009
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280998200Medicaid
FL58914ZMedicare PIN
FL280998200Medicaid