Provider Demographics
NPI:1205807120
Name:LAO, ESTHER SUN (MD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:SUN
Last Name:LAO
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 1:2420 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7321
Mailing Address - Country:US
Mailing Address - Phone:918-852-4870
Mailing Address - Fax:
Practice Address - Street 1:2420 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7321
Practice Address - Country:US
Practice Address - Phone:918-852-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25327Medicare UPIN