Provider Demographics
NPI:1245471234
Name:PELAEZ, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PELAEZ
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 1:533 BOLIVAR ST
Mailing Address - Street 2:STE 566
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1349
Mailing Address - Country:US
Mailing Address - Phone:504-568-4785
Mailing Address - Fax:505-568-4460
Practice Address - Street 1:533 BOLIVAR ST
Practice Address - Street 2:STE 566
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1349
Practice Address - Country:US
Practice Address - Phone:504-568-4785
Practice Address - Fax:505-568-4460
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA206592207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1993671Medicaid