Provider Demographics
NPI:1750340592
Name:LAU, CHI TAI PETER (MD)
Entity type:Individual
Prefix:
First Name:CHI TAI
Middle Name:PETER
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5313
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-5313
Mailing Address - Country:US
Mailing Address - Phone:318-798-4539
Mailing Address - Fax:318-798-4601
Practice Address - Street 1:1015 OBRIE ST
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486-2510
Practice Address - Country:US
Practice Address - Phone:318-645-6161
Practice Address - Fax:318-798-4601
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.023409207P00000X
LA023409174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494909Medicaid
LAP00435402OtherRAILROAD MEDICARE NUMBER
LA5E741BC74Medicare PIN
LA5E741DT25Medicare PIN
LA1494909Medicaid