Provider Demographics
NPI:1538494315
Name:GROS, LAURA DUVAL (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DUVAL
Last Name:GROS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:337-355-2335
Practice Address - Street 1:18331 HWY 182 WEST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:LA
Practice Address - Zip Code:70514
Practice Address - Country:US
Practice Address - Phone:337-924-9418
Practice Address - Fax:337-924-9165
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2135104Medicaid
LAPG39OtherMEDICARE