Provider Demographics
NPI:1811083116
Name:FERNANDES, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FERNANDES
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 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:832-562-3974
Mailing Address - Fax:832-813-0233
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 520
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:832-562-3974
Practice Address - Fax:832-813-0233
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7017207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CC568OtherBLUE CROSS & BLUE SHIELD OF TEXAS
TXH41629Medicare UPIN
TX8CC568OtherBLUE CROSS & BLUE SHIELD OF TEXAS