Provider Demographics
NPI:1366430365
Name:SUAREZ, LAURA A (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:SUAREZ
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 1:14701 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4305
Mailing Address - Country:US
Mailing Address - Phone:210-490-1111
Mailing Address - Fax:210-490-3833
Practice Address - Street 1:14701 SAN PEDRO AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4305
Practice Address - Country:US
Practice Address - Phone:210-490-1111
Practice Address - Fax:210-490-3833
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2819207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5397113OtherAETNA
00347ROtherBCBS
TX1235128240OtherGROUP NPI
A002OtherCHAMPUS
TX1384695-13Medicaid
5397113OtherAETNA
C22388Medicare UPIN