Provider Demographics
NPI:1932201282
Name:LAUKHUF, EVA S (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:S
Last Name:LAUKHUF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 59TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4630
Mailing Address - Country:US
Mailing Address - Phone:941-792-1412
Mailing Address - Fax:941-795-0753
Practice Address - Street 1:1810 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4630
Practice Address - Country:US
Practice Address - Phone:941-792-1412
Practice Address - Fax:941-795-0753
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91826OtherBC/BS GROUP
FL71826OtherBC/BS
FLK2579Medicare ID - Type UnspecifiedGROUP
FL71826AMedicare ID - Type UnspecifiedINDIVIDUAL
FL71826OtherBC/BS