Basic Information
| Provider Information | |||||||||
| NPI: | 1851338321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAURIDSEN | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 W COUNTY RD 419, STE 2010 | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327654402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076353340 | ||||||||
| FaxNumber: | 3218421269 | ||||||||
| Practice Location | |||||||||
| Address1: | 1890 W COUNTY RD 419, STE 2010 | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327654402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076353340 | ||||||||
| FaxNumber: | 3218421269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME95878 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 241711001 | 01 | FL | CIGNA | OTHER | 343030 | 01 | FL | WELLCARE | OTHER | 1322613 | 01 | FL | AETNA | OTHER | 275529700 | 05 | FL | MEDICAID | 7285783 | 01 | FL | AETNA | OTHER | 53032 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |