Provider Demographics
NPI:1982085445
Name:NACOGDOCHES PODIATRY PLLC
Entity Type:Organization
Organization Name:NACOGDOCHES PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAURICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:936-569-7460
Mailing Address - Street 1:618 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4617
Mailing Address - Country:US
Mailing Address - Phone:936-569-7460
Mailing Address - Fax:936-560-5840
Practice Address - Street 1:618 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4617
Practice Address - Country:US
Practice Address - Phone:936-569-7460
Practice Address - Fax:936-560-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty