Provider Demographics
NPI:1457308462
Name:PELOQUIN, LAVAL A (MD)
Entity Type:Individual
Prefix:
First Name:LAVAL
Middle Name:A
Last Name:PELOQUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 LOGAN AVE
Mailing Address - Street 2:OCCUPATIONAL HEALTH
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1916
Mailing Address - Country:US
Mailing Address - Phone:319-235-3885
Mailing Address - Fax:319-235-3113
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:OCCUPATIONAL HEALTH
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3885
Practice Address - Fax:319-235-3113
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24456207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E42090Medicare UPIN