MEDICARE: DR. ALICIA D'ANN LAY 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	208600000X	Surgery Physician	R8594	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R8594	OTHER	TX	TEXAS MEDICAL BOARD

General Provider Information

NPI Number	:	1134568751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA D'ANN LAY M.D.

Provider Business Mailing Address
First Line	:	1419 DIAN ST APT D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3758
Country	:	US
Telephone Number	:	817-991-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 DIAN ST APT D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3758
Country	:	US
Telephone Number	:	817-991-8889
Fax Number	:

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	04/24/2019

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