Individual
LUIS FERNANDO LAOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1893 KINGSLEY AVE, SUITE C, ORANGE PARK, FL 32073-4491
(904) 276-2044
(904) 276-2106
Mailing address
1893 KINGSLEY AVE, SUITE C, ORANGE PARK, FL 32073-4491
(904) 276-2044
(904) 276-2106
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME70461
FL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME70461
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME70461
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000804185A
—
GA
01
—
110181012
RAILROAD MEDICARE
FL
05
—
2552507-00
—
FL
Enumeration date
03/18/2006
Last updated
01/23/2012
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