Individual
JUDE LAURE DIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2878
Mailing address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2878
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
259821
MA
207L00000X
Anesthesiology Physician
314213-01
NY
207L00000X
Anesthesiology Physician
Primary
4301119069
MI
207LP2900X
Pain Medicine (Anesthesiology) Physician
4301119069
MI
Other
Enumeration date
04/11/2014
Last updated
07/20/2022
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