Individual
LAURA MICHELLE DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3410 WORTH ST STE 400, DALLAS, TX 75246-2092
(214) 370-1300
(214) 370-1313
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
R3314
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372957602
—
TX
Enumeration date
05/17/2010
Last updated
03/17/2018
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