Provider Demographics
NPI:1477668978
Name:GOETZL, LAURA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:GOETZL
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 1:6410 FANNIN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3004
Mailing Address - Country:US
Mailing Address - Phone:832-325-7133
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3004
Practice Address - Country:US
Practice Address - Phone:832-325-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0208207VM0101X
SC27525207VG0400X, 207VM0101X
PAMD446436207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3922OtherMEDICARE GROUP
SCUSC001OtherMEDICAID GROUP
SC275251Medicaid
SCAA0747Medicare UPIN
SC275251Medicaid