Provider Demographics
NPI:1902244197
Name:LAU, PATRICIO E (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:E
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 60TH CT STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4070
Mailing Address - Country:US
Mailing Address - Phone:305-662-8320
Mailing Address - Fax:305-665-2467
Practice Address - Street 1:3200 SW 60TH CT STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4070
Practice Address - Country:US
Practice Address - Phone:305-662-8320
Practice Address - Fax:305-665-2467
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10046909208600000X
FLME1454672086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery