Provider Demographics
NPI:1558670901
Name:KENNETH J LAURORA MD PA
Entity Type:Organization
Organization Name:KENNETH J LAURORA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAURORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-327-1020
Mailing Address - Street 1:400 BYPASS LN STE 111
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-7380
Mailing Address - Country:US
Mailing Address - Phone:936-327-1020
Mailing Address - Fax:936-327-1022
Practice Address - Street 1:400 BYPASS LN STE 111
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-7380
Practice Address - Country:US
Practice Address - Phone:936-327-1020
Practice Address - Fax:936-327-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296647501Medicaid
TX158661202Medicaid
TX296647502Medicaid
TXTXB118014Medicare PIN
TX296647502Medicaid