Individual
JODY B LAURENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5 MEDICAL PLAZA DR STE 110, ROSEVILLE, CA 95661-2866
(916) 483-1493
(888) 411-8530
Mailing address
PO BOX 2033, FOLSOM, CA 95763-2033
(916) 483-1493
(888) 411-8530
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E4155
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E41550
—
CA
Enumeration date
10/19/2006
Last updated
08/01/2016
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