Provider Demographics
NPI:1104084110
Name:WEBB, LAURA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3500 ALAMEDA DE LAS PULGAS STE 200
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6569
Mailing Address - Country:US
Mailing Address - Phone:650-815-9577
Mailing Address - Fax:
Practice Address - Street 1:3500 ALAMEDA DE LAS PULGAS STE 200
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6569
Practice Address - Country:US
Practice Address - Phone:650-815-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics