Individual provider · NPI-1

Jody B Laurence, DPM

Podiatrist, Primary Podiatric Medicine · Roseville, CA

NPI number1972685378
StatusActive
Last updated in NPPESAug 1, 2016

Details

NPI
1972685378
Entity type
Individual (NPI-1)
Name
Jody B Laurence
Credential
DPM
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 19, 2006
Last updated
Aug 1, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213EP1101X Podiatrist, Primary Podiatric MedicineE4155CAYes

Practice location

5 Medical Plaza Dr Ste 110
Roseville, CA 95661-2866

Phone 916-483-1493 · Fax 888-411-8530

Mailing address

Po Box 2033
Folsom, CA 95763-2033

Phone 916-483-1493 · Fax 888-411-8530

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