Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 28780 | AL |
NPI | 1043429392 |
---|---|
Provider Name | Laura Tucker Cepeda |
First Address | Fairhope, AL 36532-3349 |
Second Address | Fairhope, AL 36532-3349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 28/06/2010 |