Provider Demographics
NPI:1609083203
Name:HAYGOOD, LAURA JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JENNIFER
Last Name:HAYGOOD
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 1:455 RICE ROAD
Mailing Address - Street 2:STE. 104
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3604
Mailing Address - Country:US
Mailing Address - Phone:903-597-3376
Mailing Address - Fax:903-526-7703
Practice Address - Street 1:455 RICE ROAD
Practice Address - Street 2:STE. 104
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3604
Practice Address - Country:US
Practice Address - Phone:903-597-3376
Practice Address - Fax:903-526-7703
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3905174400000X, 207NI0002X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082DNOtherBCBS
TX8C9410Medicare PIN
TX00742XMedicare PIN
TXG95735Medicare UPIN