Provider Demographics
NPI:1518345388
Name:IRVIN, LAURA (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:IRVIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD
Practice Address - Street 2:STE 208, 303 & 304
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8952
Practice Address - Country:US
Practice Address - Phone:254-741-1400
Practice Address - Fax:254-741-1428
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2885207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine