Provider Demographics
NPI:1861803801
Name:JOHN P LAVERY, MD, PA
Entity type:Organization
Organization Name:JOHN P LAVERY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-747-0709
Mailing Address - Street 1:997 RAINTREE CIR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4949
Mailing Address - Country:US
Mailing Address - Phone:972-747-0709
Mailing Address - Fax:972-747-7991
Practice Address - Street 1:997 RAINTREE CIR
Practice Address - Street 2:SUITE 120
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4949
Practice Address - Country:US
Practice Address - Phone:972-747-0709
Practice Address - Fax:972-747-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1021094291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty