Healthcare Provider Details

I. General information

NPI: 1558749390
Provider Name (Legal Business Name): LARA PAVAGEAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W PARKER RD
PLANO TX
75093-8185
US

IV. Provider business mailing address

1121 E SPRING CREEK PKWY. STE. 110, #319
PLANO TX
75074
US

V. Phone/Fax

Practice location:
  • Phone: 972-981-8000
  • Fax:
Mailing address:
  • Phone: 214-343-6663
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberT0599
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT0599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: