Provider Demographics
NPI:1093882110
Name:LAURIE, SCOT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:
Last Name:LAURIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N I 35
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5266
Mailing Address - Country:US
Mailing Address - Phone:972-923-9200
Mailing Address - Fax:972-923-9201
Practice Address - Street 1:2460 N I 35
Practice Address - Street 2:SUITE 220
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5266
Practice Address - Country:US
Practice Address - Phone:972-923-9200
Practice Address - Fax:972-923-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2947207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH50069Medicare UPIN