Basic Information
| Provider Information | |||||||||
| NPI: | 1134108186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUDICINA | ||||||||
| FirstName: | LAURENCE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 JEFFERSON ST NE STE 800 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871092132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054186636 | ||||||||
| FaxNumber: | 5055215160 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 JEFFERSON ST NE STE 800 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871092132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059327112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | MD2008-0045 | NM | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | MD2008-0045 | NM | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 76736326 | 05 | NM | MEDICAID |