Healthcare Provider Details

I. General information

NPI: 1396976668
Provider Name (Legal Business Name): LAURIE KATHERINE SEREMETIS M.D., M.P.AFF.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE KATHERINE VEDDER M.D.

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST
BRYAN TX
77802-2622
US

IV. Provider business mailing address

2900 E 29TH ST
BRYAN TX
77802-2622
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-8200
  • Fax:
Mailing address:
  • Phone: 979-774-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberJ9334
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ9334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: