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NPI Code Detail

MEDICARE: LAURA PETREY M.D.

MEDICARE: LAURA PETREY 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
12086S0127XTrauma Surgery PhysicianL2824TX

Other Identifiers

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

General Provider Information

NPI Number : 1831128644
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA PETREY M.D.
Provider Business Mailing Address
First Line : 3701 JUNIUS ST
Second Line : CS11 G006
City : DALLAS
State : TX
Zip : 75246-2026
Country : US
Telephone Number : 214-821-1599
Fax Number : 214-821-8985
Provider Business Practice Location Address
First Line : 2710 SWISS AVENUE
Second Line :
City : DALLAS
State : TX
Zip : 75204-5900
Country : US
Telephone Number : 214-821-1599
Fax Number : 214-821-8985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2006
Last Update Date : 09/28/2012

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Directions to “ LAURA PETREY M.D.” Practice Location

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