Provider Demographics
NPI:1396969424
Name:LAURENTS, CRAIG (LSA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:LAURENTS
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 HONEY TREE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6742
Mailing Address - Country:US
Mailing Address - Phone:512-632-7561
Mailing Address - Fax:512-328-7160
Practice Address - Street 1:3016 HONEY TREE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6742
Practice Address - Country:US
Practice Address - Phone:512-632-7561
Practice Address - Fax:512-328-7160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21LFOtherBLUE CROSS BLUE SHIELD