Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | K2947 | TX |
NPI | 1093882110 |
---|---|
Provider Name | Dr. Scot Laurie |
First Address | Waxahachie, TX 75165-5266 |
Second Address | Waxahachie, TX 75165-5266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H50069 | (02) | TX |