Provider Demographics
NPI:1851338321
Name:LAURIDSEN, DEBORAH I (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:I
Last Name:LAURIDSEN
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 1:1890 W COUNTY RD 419, STE 2010
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4402
Mailing Address - Country:US
Mailing Address - Phone:407-635-3340
Mailing Address - Fax:321-842-1269
Practice Address - Street 1:1890 W COUNTY RD 419, STE 2010
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4402
Practice Address - Country:US
Practice Address - Phone:407-635-3340
Practice Address - Fax:321-842-1269
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL241711001OtherCIGNA
FL343030OtherWELLCARE
FL1322613OtherAETNA
FL275529700Medicaid
FL7285783OtherAETNA
FL53032OtherBLUE CROSS BLUE SHIELD
FL343030OtherWELLCARE
U7735VMedicare PIN
FL241711001OtherCIGNA