Provider Demographics
NPI:1922035872
Name:KEZAR, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KEZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16222208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934107Medicaid
AL051506610OtherBLUE CROSS
AL000025167OtherBLUE CROSS
AL000025167Medicaid
AL051531011OtherBLUE CROSS
ALE91376OtherVIVA
MS04459376OtherMISSISSIPPI MEDICAID
AL051551612Medicaid
AL000025167OtherMEDICARE
AL051500008OtherBLUE CROSS
AL051506610OtherBLUE CROSS