Provider Demographics
NPI:1134134406
Name:MCLAUGHLIN, EMILY B (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:B
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-870-4893
Practice Address - Street 1:1200 W. MAGNOLIA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4833
Practice Address - Country:US
Practice Address - Phone:817-870-4833
Practice Address - Fax:817-870-4893
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL74812086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00201476OtherRAILROAD MEDICARE
TX165907001Medicaid
TX165907001Medicaid