Provider Demographics
NPI:1588690903
Name:LAQUA, PATRICIA L (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:LAQUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-2484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5800
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:701-234-8803
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27243OtherNDBS #
MN759S5LAOtherMNBS #
ND0124374OtherMEDICA #
ND181850OtherUCARE #
ND0124375OtherMEDICA #
MN816183600Medicaid
ND0124373OtherMEDICA #
ND13584Medicaid
NDHP69894OtherHEALTHPARTNERS #
ND2444457OtherAMERICA'S PPO-ARAZ #
ND648N0LAOtherMNBS #
NDDA9011045621OtherPREFERRED ONE #
NDP00345320Medicare ID - Type UnspecifiedRR MEDICARE #
NDDA9011045621OtherPREFERRED ONE #
ND648N0LAOtherMNBS #