Provider Demographics
NPI:1255400370
Name:PETERSON, LAURA D (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:D
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1907 S BERETANIA ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1301
Mailing Address - Country:US
Mailing Address - Phone:808-949-3444
Mailing Address - Fax:808-949-7808
Practice Address - Street 1:1907 S BERETANIA ST
Practice Address - Street 2:SUITE 501
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1301
Practice Address - Country:US
Practice Address - Phone:808-949-3444
Practice Address - Fax:808-949-7808
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12588208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000250324OtherHMSA
HI3226444OtherUHA
HI559479Medicaid
HI0000250324OtherHMSA
HI559479Medicaid