Provider Demographics
NPI:1740288257
Name:MCANALLY, LAURIE MELINDA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MELINDA
Last Name:MCANALLY
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 1:4224 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4843
Mailing Address - Country:US
Mailing Address - Phone:325-793-2348
Mailing Address - Fax:
Practice Address - Street 1:4224 S 20TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4843
Practice Address - Country:US
Practice Address - Phone:325-793-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8160B0Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TXG33169Medicare UPIN