Provider Demographics
NPI:1154322592
Name:LIGON, LAURENCE ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:ASHLEY
Last Name:LIGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:912 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5264
Mailing Address - Country:US
Mailing Address - Phone:512-306-8360
Mailing Address - Fax:512-306-8176
Practice Address - Street 1:912 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5264
Practice Address - Country:US
Practice Address - Phone:512-306-8360
Practice Address - Fax:512-306-8176
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24394Medicare UPIN