MEDICARE: LAUREN FITZGERALD UNDERWOOD 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	208600000X	Surgery Physician	BP10043376	TX
2	208800000X	Urology Physician	R3448	TX

General Provider Information

NPI Number	:	1871854885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN FITZGERALD UNDERWOOD M.D.

Provider Business Mailing Address
First Line	:	7909 FREDERICKSBURG RD STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3400
Country	:	US
Telephone Number	:	210-614-4544
Fax Number	:	210-679-3936

Provider Business Practice Location Address
First Line	:	1303 MCCULLOUGH AVE STE 270
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-5604
Country	:	US
Telephone Number	:	210-474-7020
Fax Number	:	210-679-3733

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	07/21/2022

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