Provider Demographics
NPI:1316127368
Name:EDWARDS, LAURA D (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 DOMINION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2083
Mailing Address - Country:US
Mailing Address - Phone:281-578-5479
Mailing Address - Fax:281-578-9704
Practice Address - Street 1:848 DOMINION DR STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2083
Practice Address - Country:US
Practice Address - Phone:281-578-5479
Practice Address - Fax:281-578-9704
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4358208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0601Medicare PIN