Healthcare Provider Details

I. General information

NPI: 1881806461
Provider Name (Legal Business Name): LAURA ELIZABETH ANTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 SHELF ROCK
DRIFTWOOD TX
78619-4377
US

IV. Provider business mailing address

313 SHELF ROCK
DRIFTWOOD TX
78619-4377
US

V. Phone/Fax

Practice location:
  • Phone: 512-829-4604
  • Fax:
Mailing address:
  • Phone: 512-829-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK7173
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: