Provider Demographics
NPI:1760667547
Name:LAURA G POWER MD PA
Entity Type:Organization
Organization Name:LAURA G POWER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-579-0084
Mailing Address - Street 1:1305 PALUXY RD STE B
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5641
Mailing Address - Country:US
Mailing Address - Phone:817-579-0084
Mailing Address - Fax:817-579-0021
Practice Address - Street 1:1305 PALUXY RD STE B
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5641
Practice Address - Country:US
Practice Address - Phone:817-579-0084
Practice Address - Fax:817-579-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-30
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158953301Medicaid
TX0010KKOtherBCBS