Basic Information
| Provider Information | |||||||||
| NPI: | 1710940705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAU | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | LIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 N STAPLEY DR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852033002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808347546 | ||||||||
| FaxNumber: | 4808338313 | ||||||||
| Practice Location | |||||||||
| Address1: | 5656 S POWER RD | ||||||||
| Address2: | STE 126 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852958489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808347546 | ||||||||
| FaxNumber: | 4808338313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30826 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 726440 | 05 | AZ | MEDICAID |