Provider Demographics
NPI:1760644785
Name:SPECK, LAURA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:SPECK
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 1:327 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4577
Mailing Address - Country:US
Mailing Address - Phone:512-615-3280
Mailing Address - Fax:512-666-3763
Practice Address - Street 1:327 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4577
Practice Address - Country:US
Practice Address - Phone:512-615-3280
Practice Address - Fax:512-546-7340
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0299207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2825861-01Medicaid
TX8CW890OtherBCBSTX
TXTXB131209Medicare PIN
TXTXB131210Medicare PIN