Provider Demographics
NPI:1184606378
Name:LAURORA, KENNETH J (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:LAURORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 BYPASS LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8413
Mailing Address - Country:US
Mailing Address - Phone:936-327-1020
Mailing Address - Fax:936-327-1022
Practice Address - Street 1:300 BYPASS LN
Practice Address - Street 2:SUITE 208
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8413
Practice Address - Country:US
Practice Address - Phone:936-327-1020
Practice Address - Fax:936-327-1022
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158661202Medicaid
TX296647502Medicaid
830360404OtherEIN
TX296647502Medicaid
TX00695PMedicare PIN
TX158661202Medicaid
TXTXB118015Medicare PIN