Provider Demographics
NPI:1376992578
Name:JANSKY, LAURIE LYNETTE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LYNETTE
Last Name:JANSKY
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 1:3650 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707
Mailing Address - Country:US
Mailing Address - Phone:409-838-0346
Mailing Address - Fax:409-839-3720
Practice Address - Street 1:3650 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-838-0346
Practice Address - Fax:409-839-3720
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine