Provider Demographics
NPI:1457692683
Name:HUFF, LAURA BOWMAN (DO)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BOWMAN
Last Name:HUFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MICHELE
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5352
Mailing Address - Fax:
Practice Address - Street 1:2017 JEFFERSON ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2419
Practice Address - Country:US
Practice Address - Phone:540-981-8025
Practice Address - Fax:540-853-0511
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22845363A00000X
VA01022079132084P0800X
VA01160331372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA22845OtherLICENSE
CAPA22845OtherLICENSE