Provider Demographics
NPI:1437122256
Name:LAUER, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30321 ROOSEVELT CT
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-6903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 BALLPARK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2364
Practice Address - Country:US
Practice Address - Phone:605-720-1389
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5604117Medicaid
SD5604117Medicaid
SD41653Medicare ID - Type Unspecified