Individual
LAURIE BOQUET DORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
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 NUMBER
TX
05
—
146028901
—
TX
01
—
3378225
BCBS BLUE LINK NUMBER
TX
01
—
7540001
AETNA
TX
Enumeration date
11/29/2005
Last updated
07/28/2008
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