MEDICARE: MS. LAURA HOLLIS PETERKIN PA

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	363AM0700X	Medical Physician Assistant	PA03086	TX

General Provider Information

NPI Number	:	1972661429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA HOLLIS PETERKIN PA

Provider Business Mailing Address
First Line	:	275 LANTERN BEND DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2831
Country	:	US
Telephone Number	:	281-440-0101
Fax Number	:	281-440-6441

Provider Business Practice Location Address
First Line	:	275 LANTERN BEND DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2831
Country	:	US
Telephone Number	:	281-440-0101
Fax Number	:	281-440-1153

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	06/19/2014

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