Provider Demographics
NPI:1689674046
Name:LU, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4664
Mailing Address - Country:US
Mailing Address - Phone:985-892-7621
Mailing Address - Fax:
Practice Address - Street 1:800 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 2C
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4664
Practice Address - Country:US
Practice Address - Phone:985-892-7621
Practice Address - Fax:504-246-9778
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA20777207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF66149Medicare UPIN