Provider Demographics
NPI:1346284627
Name:LAWRENCE, LAURA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:T
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5477 GLEN LAKES DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-363-5965
Mailing Address - Fax:214-363-0639
Practice Address - Street 1:5477 GLEN LAKES DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-363-5965
Practice Address - Fax:214-363-0639
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006012216207VG0400X
TXN4245207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200916302Medicaid
I62676Medicare UPIN