Provider Demographics
NPI:1396788626
Name:SHAUN E LAURIE PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:SHAUN E LAURIE PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAURIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-309-1331
Mailing Address - Street 1:1628 N PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-2300
Mailing Address - Country:US
Mailing Address - Phone:850-309-1331
Mailing Address - Fax:850-309-1332
Practice Address - Street 1:1628 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-2300
Practice Address - Country:US
Practice Address - Phone:850-309-1331
Practice Address - Fax:850-309-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9254Medicare ID - Type Unspecified