MEDICARE: ALLERGY & ASTHMA CENTER AT NORTHPARK

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	207K00000X	Allergy & Immunology Physician	K2947	TX

General Provider Information

NPI Number	:	1598825408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY & ASTHMA CENTER AT NORTHPARK

Provider Business Mailing Address
First Line	:	2460 N I35 EAST
Second Line	:	SUITE 220
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-5266
Country	:	US
Telephone Number	:	972-923-9200
Fax Number	:	972-923-9201

Provider Business Practice Location Address
First Line	:	2460 N I35 EAST
Second Line	:	SUITE 220
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-5266
Country	:	US
Telephone Number	:	972-923-9200
Fax Number	:	972-923-9201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOT LAURIE
Credential	:	M.D.
Telephone Number	:	214-923-7611

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/19/2025

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