MEDICARE: LAURA BIRNBAUM, M.D., P.A.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780626390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA BIRNBAUM, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1618
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-1478
Country	:	US
Telephone Number	:	979-542-9000
Fax Number	:	979-542-9002

Provider Business Practice Location Address
First Line	:	189 S MANSE AVE
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-3451
Country	:	US
Telephone Number	:	979-542-9000
Fax Number	:	979-542-9002

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. LAURA M. BIRNBAUM
Credential	:	M.D.
Telephone Number	:	979-542-9000

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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