Organization
LAURIE BOQUET DORY, M.D.P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIE BOQUET DORY M.D. (OWNER)
(817) 332-5585
Entity
Organization
Contact information
Practice address
901 TRAVIS AVE, FORT WORTH, TX 76104-3137
(817) 332-5585
(817) 332-5377
Mailing address
901 TRAVIS AVE, FORT WORTH, TX 76104-3137
(817) 332-5585
(817) 332-5377
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J4779
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076EQ
BCBS
TX
05
—
1460289-01
—
TX
01
—
180041477
RAILROAD MEDICARE
TX
01
—
2075692
CIGNA
TX
01
—
3378225
BCBS BLUE LINK
TX
01
—
7540001
AETNA
TX
Enumeration date
03/29/2012
Last updated
03/29/2012
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