Provider Demographics
NPI:1659392058
Name:POWER, LAURA G (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:POWER
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 1:1308 PALUXY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5609
Mailing Address - Country:US
Mailing Address - Phone:817-579-3996
Mailing Address - Fax:817-579-3995
Practice Address - Street 1:1308 PALUXY RD STE 301
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5609
Practice Address - Country:US
Practice Address - Phone:817-579-3996
Practice Address - Fax:817-579-3995
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158954101Medicaid
TX10011167OtherAMERIGROUP
TXH88156Medicare UPIN