MEDICARE: DR. LAURA M BIRNBAUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L7981	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053309088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA M BIRNBAUM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1618
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-1478
Country	:	US
Telephone Number	:	979-542-9000
Fax Number	:	979-542-9002

Provider Business Practice Location Address
First Line	:	219A E RAILROAD ROW
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-2639
Country	:	US
Telephone Number	:	979-542-9000
Fax Number	:	979-542-9002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	01/13/2014

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