Provider Demographics
NPI:1427027333
Name:LAUE, BRYAN WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:WALTER
Last Name:LAUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1963 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE #5
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5036
Mailing Address - Country:US
Mailing Address - Phone:256-265-2464
Mailing Address - Fax:256-265-2469
Practice Address - Street 1:1963 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE #5
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5036
Practice Address - Country:US
Practice Address - Phone:256-265-2464
Practice Address - Fax:256-265-2469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G55147Medicare UPIN