Individual
LAURA A JOQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
47011
MN
207RH0000X
Hematology (Internal Medicine) Physician
47011
MN
207RH0003X
Hematology & Oncology Physician
MD27329
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006200
—
OR
05
—
074970200
—
MN
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P00198296
RAILROAD MEDICARE
MN
Enumeration date
01/17/2006
Last updated
01/08/2016
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