Provider Demographics
NPI:1053309088
Name:BIRNBAUM, LAURA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1618
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-1478
Mailing Address - Country:US
Mailing Address - Phone:979-542-9000
Mailing Address - Fax:979-542-9002
Practice Address - Street 1:219A E RAILROAD ROW
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-2639
Practice Address - Country:US
Practice Address - Phone:979-542-9000
Practice Address - Fax:979-542-9002
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175749401Medicaid
TX8F0855Medicare PIN
TX00313ZMedicare PIN
TXI38667Medicare UPIN