Provider Demographics
NPI:1578557211
Name:WHITELEY, LAURA LINGLE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LINGLE
Last Name:WHITELEY
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 1:11415 S CHESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2733
Mailing Address - Country:US
Mailing Address - Phone:713-984-8709
Mailing Address - Fax:
Practice Address - Street 1:915 GESSNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2527
Practice Address - Country:US
Practice Address - Phone:713-242-2222
Practice Address - Fax:713-242-2266
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7250207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160617004Medicaid
TX7603509OtherAETNA
TX8S5470OtherBCBS
TX10011216OtherAMERIGROUP
TX8D5011Medicare ID - Type Unspecified
TX7603509OtherAETNA