Provider Demographics
NPI:1023338688
Name:ENOMOTO, LAURA M (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:ENOMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415000-MSC8159
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-8159
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:1926 ALCOA HWY STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1555
Practice Address - Country:US
Practice Address - Phone:865-544-9218
Practice Address - Fax:865-305-8262
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2021-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT197293208600000X
TN599532086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery