Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD2008-0045 | NM |
NPI | 1134108186 |
---|---|
Provider Name | Laurence R Laudicina |
First Address | Albuquerque, NM 87125-6028 |
Second Address | Albuquerque, NM 87109-5900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 23/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76736326 | (05) | NM |