Provider Demographics
NPI:1992708788
Name:LAUREL, EDGARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
Last Name:LAUREL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2322
Mailing Address - Country:US
Mailing Address - Phone:602-997-0484
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:2545 E THOMAS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7969
Practice Address - Country:US
Practice Address - Phone:602-419-3637
Practice Address - Fax:602-595-1528
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21887207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151605Medicaid
F70767Medicare UPIN
AZ28519Medicare PIN