Provider Demographics
NPI:1447568241
Name:DIPUMA, LAURA L (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:DIPUMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:569 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3911
Mailing Address - Country:US
Mailing Address - Phone:731-423-0975
Mailing Address - Fax:731-424-5061
Practice Address - Street 1:2027 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3576
Practice Address - Country:US
Practice Address - Phone:731-668-6882
Practice Address - Fax:731-668-6882
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000026903207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology