Individual
MRS. LAURA ANN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA04491
TX
363AS0400X
Surgical Physician Assistant
Primary
PA04491
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190535803
—
TX
05
—
190535804
—
TX
01
—
8N8469
BCBS OF TEXAS
TX
Enumeration date
08/01/2006
Last updated
12/12/2019
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