Provider Demographics
NPI:1750330171
Name:LAUDENBACH, BONNIE LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LOU
Last Name:LAUDENBACH
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 1:841 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3019
Mailing Address - Country:US
Mailing Address - Phone:606-324-1170
Mailing Address - Fax:606-324-1077
Practice Address - Street 1:841 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3019
Practice Address - Country:US
Practice Address - Phone:606-324-1170
Practice Address - Fax:606-324-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64007560Medicaid
KY4037021OtherAETNA
KY000000107798OtherBLUE CROSS BLUE SHIELD
KY00234001Medicare PIN
KY000000107798OtherBLUE CROSS BLUE SHIELD
KY4037021OtherAETNA