Provider Demographics
NPI:1043429392
Name:CEPEDA, LAURA TUCKER (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TUCKER
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 ROCK CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3349
Mailing Address - Country:US
Mailing Address - Phone:251-928-3384
Mailing Address - Fax:251-928-3353
Practice Address - Street 1:202 ROCK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3349
Practice Address - Country:US
Practice Address - Phone:251-928-3844
Practice Address - Fax:251-928-3353
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL28780207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I07009Medicare PIN