=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093882110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOT LAURIE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 11/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2460 N I 35 SUITE 220
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-5266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-923-9200
-----------------------------------------------------
Fax | 972-923-9201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2460 N I 35 SUITE 220
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-5266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-923-9200
-----------------------------------------------------
Fax | 972-923-9201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | K2947
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------