Provider Demographics
NPI:1982604658
Name:FERTAK, LAURA MURPHY (PAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MURPHY
Last Name:FERTAK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-3595
Mailing Address - Fax:713-793-7107
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-3595
Practice Address - Fax:713-793-7107
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00454363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331502001Medicaid
616771101OtherUS DEPT OF LABOR
616771105OtherUS DEPT OF LABOR
TX1982604658OtherBLUE CROSS BLUE SHIELD
TX8Y0159OtherBCBS
TXP00369474OtherMEDICARE RAILROAD
TXP01170506OtherRR MEDICARE
TX331502002Medicaid
601771109OtherUS DEPT OF LABOR
616771110OtherUS DEPT OF LABOR
86N043OtherBCBSTX
TXTXB151256Medicare PIN
TX8L0388Medicare PIN
TX8G3722Medicare PIN
TX331502002Medicaid
601771109OtherUS DEPT OF LABOR
TX8Y0159OtherBCBS
TX331502001Medicaid
TXTXB124210Medicare PIN
TX503208ZSWDMedicare PIN