Provider Demographics
NPI:1992148035
Name:PETER, LAURA R (DO)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:R
Last Name:PETER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1577 ROBERTS DRIVE
Mailing Address - Street 2:SUITE #323
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-241-9775
Mailing Address - Fax:904-249-3638
Practice Address - Street 1:1577 ROBERTS DR STE 323
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3266
Practice Address - Country:US
Practice Address - Phone:904-241-9775
Practice Address - Fax:904-249-3638
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS14544207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics