Provider Demographics
NPI:1841390655
Name:LOPEZ-CONCEPCION, LAURA LAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LAGO
Last Name:LOPEZ-CONCEPCION
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 1:2802 WEBBERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2947
Mailing Address - Country:US
Mailing Address - Phone:512-972-4792
Mailing Address - Fax:
Practice Address - Street 1:2802 WEBBERVILLE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2947
Practice Address - Country:US
Practice Address - Phone:512-972-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0653Medicare PIN
TXG28622Medicare UPIN