Provider Demographics
NPI:1063579316
Name:LAURA, JOHN PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:LAURA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3333 W COAST HWY
Mailing Address - Street 2:# 500
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4036
Mailing Address - Country:US
Mailing Address - Phone:949-646-0077
Mailing Address - Fax:949-646-6678
Practice Address - Street 1:3333 W COAST HWY
Practice Address - Street 2:# 500
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4036
Practice Address - Country:US
Practice Address - Phone:949-646-0077
Practice Address - Fax:949-646-6678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine