Provider Demographics
NPI:1932179595
Name:LAURON, MARK P (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:P
Last Name:LAURON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16024 KAMANA ROAD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-3644
Mailing Address - Fax:760-242-4414
Practice Address - Street 1:16024 KAMANA ROAD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-3644
Practice Address - Fax:760-242-4414
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA61892207R00000X
CA00A618920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73302Medicare UPIN
CA00A618920Medicare ID - Type Unspecified