Provider Demographics
NPI:1366445579
Name:PREWITT-BUCHANAN, LAURA K (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:PREWITT-BUCHANAN
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 1:607 BLUE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3908
Mailing Address - Country:US
Mailing Address - Phone:512-496-8605
Mailing Address - Fax:512-892-5071
Practice Address - Street 1:607 BLUE HILLS DR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3908
Practice Address - Country:US
Practice Address - Phone:512-496-8605
Practice Address - Fax:512-892-5071
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9254208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116998904Medicaid
TX116998904Medicaid
TX8788B7Medicare PIN