Individual
BRIAN T LAURSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 432-5075
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 432-5075
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000668A
IN
Other
Enumeration date
05/23/2005
Last updated
09/19/2023
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