Provider Demographics
NPI:1255764379
Name:LAU, ALEXANDER HERMAN (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HERMAN
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25050 SE STARK ST
Mailing Address - Street 2:STE 300
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3383
Mailing Address - Country:US
Mailing Address - Phone:503-667-8878
Mailing Address - Fax:503-667-0310
Practice Address - Street 1:25050 SE STARK ST
Practice Address - Street 2:STE 300
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3383
Practice Address - Country:US
Practice Address - Phone:503-667-8878
Practice Address - Fax:503-667-0310
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2016-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD174807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500704124Medicaid