MEDICARE: DR. SANDRA LAURIAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	K4479	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K4479	OTHER	TX	TX LICENSE

General Provider Information

NPI Number	:	1134107634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA LAURIAT M.D.

Provider Business Mailing Address
First Line	:	1505 LBJ FWY STE 700
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-6065
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:	214-579-6941

Provider Business Practice Location Address
First Line	:	2005 W PARK DR STE 200
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-2034
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:	214-579-6984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	12/15/2023

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