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General NPI Number Information
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NPI Number | 1043487630
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Entity Type | Individual
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Provider Name | MICHELLE MARIE LAW D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 5400 CROSSLAKE PKWY
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City | WACO
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State | TX
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Zip | 76712-6977
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Country | US
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Telephone | 254-420-2336
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Fax |
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Provider Business Mailing Address
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Address Line | 254 BROOKHAVEN DR
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City | WACO
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State | TX
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Zip | 76712-2701
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Country | US
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Telephone | 254-855-3345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OT011596
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | N1730
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License Number State | TX
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