Provider Demographics
NPI:1720743982
Name:LAVEAR MEDICAL, P.A
Entity Type:Organization
Organization Name:LAVEAR MEDICAL, P.A
Other - Org Name:COWTOWN HEADACHE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:636-575-0888
Mailing Address - Street 1:3912 HOMESTEAD CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-6205
Mailing Address - Country:US
Mailing Address - Phone:636-575-0888
Mailing Address - Fax:
Practice Address - Street 1:4055 INTERNATIONAL PLZ STE 660
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4874
Practice Address - Country:US
Practice Address - Phone:817-592-8427
Practice Address - Fax:833-630-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty