Provider Demographics
NPI:1962502294
Name:CAVANAUGH, LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:CAVANAUGH
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:PO BOX 869380
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-9380
Mailing Address - Country:US
Mailing Address - Phone:972-758-3598
Mailing Address - Fax:972-599-9604
Practice Address - Street 1:7000 W PLANO PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8466
Practice Address - Country:US
Practice Address - Phone:972-300-4200
Practice Address - Fax:972-300-4201
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL56962080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V0284OtherBCBS