Organization
ADAGIO DERMATOLOGY AND AESTHETICS, P.A.
Active
Other names
Laura J. Haygood, M.D., P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA JENNIFER HAYGOOD M.D. (PRESIDENT)
(903) 597-3376
Entity
Organization
Contact information
Practice address
455 RICE ROAD, STE. 104, TYLER, TX 75703-3604
(903) 597-3376
(903) 526-7703
Mailing address
455 RICE ROAD, STE. 104, TYLER, TX 75703-3604
(903) 597-3376
(903) 526-7703
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
K3905
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0082DN
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/19/2005
Last updated
08/12/2015
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