Provider Demographics
NPI:1255529384
Name:DRACH, LAURA L (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:DRACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:BOX 6941
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4243
Practice Address - Fax:727-767-8612
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10565208M00000X, 2080H0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2986311OtherCIGNA
FL510656OtherSTAYWELL/HEALTHEASE
FL000964300Medicaid
FL1456WOtherBLUE CROSS/BLUE SHIELD OF FLORIDA
FL9183364OtherAETNA
FL328868OtherAVMED