Provider Demographics
NPI:1881753838
Name:LAUZAU, FRANK JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JUSTIN
Last Name:LAUZAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:419 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-2872
Mailing Address - Country:US
Mailing Address - Phone:336-623-4278
Mailing Address - Fax:336-623-4304
Practice Address - Street 1:419 SHERWOOD CT
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-2872
Practice Address - Country:US
Practice Address - Phone:336-623-4278
Practice Address - Fax:336-623-4304
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-28251207R00000X
VA0101-034672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018217Medicaid
NC8951189Medicaid
203200Medicare ID - Type Unspecified
NC8951189Medicaid