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NPI Code Detail

MEDICARE: LAURA L MCDONOUGH PA-C

MEDICARE: LAURA L MCDONOUGH PA-C
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
1363A00000XPhysician AssistantPA01102TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28N3085OTHERTXBCBS

General Provider Information

NPI Number : 1922098268
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA L MCDONOUGH PA-C
Provider Business Mailing Address
First Line : 3900 JUNIUS ST
Second Line : SUITE 500
City : DALLAS
State : TX
Zip : 75246-1615
Country : US
Telephone Number : 214-823-7090
Fax Number : 214-823-1644
Provider Business Practice Location Address
First Line : 3900 JUNIUS ST
Second Line : SUITE 500
City : DALLAS
State : TX
Zip : 75246-1615
Country : US
Telephone Number : 214-823-7090
Fax Number : 214-823-1644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 06/19/2023

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Directions to “ LAURA L MCDONOUGH PA-C” Practice Location

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