Provider Demographics
NPI:1518950849
Name:LAURA D EDWARDS MD PA
Entity Type:Organization
Organization Name:LAURA D EDWARDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:281-578-5479
Mailing Address - Street 1:848 DOMINION DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2023
Mailing Address - Country:US
Mailing Address - Phone:281-578-5479
Mailing Address - Fax:281-578-9704
Practice Address - Street 1:848 DOMINION DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2023
Practice Address - Country:US
Practice Address - Phone:281-578-5479
Practice Address - Fax:281-578-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4358208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00136ZMedicare ID - Type Unspecified
C15440Medicare UPIN