Provider Demographics
NPI:1922060789
Name:HARN, LAURA KAY (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:HARN
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 1:4040 LEGACY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6748
Mailing Address - Country:US
Mailing Address - Phone:972-668-6705
Mailing Address - Fax:
Practice Address - Street 1:4040 LEGACY DR STE 201
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6748
Practice Address - Country:US
Practice Address - Phone:972-668-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175623101Medicaid
I40330Medicare UPIN
TX175623101Medicaid