Basic Information
Provider Information
NPI: 1992711105
EntityType: 2
ReplacementNPI:  
OrganizationName: LAURETTE C. ROBEY, MD PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2001 N GRANVILLE AVE
Address2:  
City: MUNCIE
State: IN
PostalCode: 473032110
CountryCode: US
TelephoneNumber: 7652840493
FaxNumber: 7652842434
Practice Location
Address1: 10343 DAWSONS CREEK BLVD
Address2: #6C
City: FORT WAYNE
State: IN
PostalCode: 468251906
CountryCode: US
TelephoneNumber: 2604978677
FaxNumber: 2601978817
Other Information
ProviderEnumerationDate: 07/31/2006
LastUpdateDate: 02/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ROBEY
AuthorizedOfficialFirstName: LAURETTE
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 2604978677
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VG0400X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology

No ID Information.


Home