Provider Demographics
NPI:1326452152
Name:BRANNEN, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRANNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MADISON OAK DR
Mailing Address - Street 2:STE 440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4189
Mailing Address - Country:US
Mailing Address - Phone:303-318-3830
Mailing Address - Fax:303-318-3825
Practice Address - Street 1:502 MADISON OAK DR
Practice Address - Street 2:STE 440
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-946-1300
Practice Address - Fax:210-946-1700
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6349207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR6349OtherMEDICAL LICENSE
TX386207001Medicaid