Provider Demographics
NPI:1881778561
Name:DAVIDSON, LAURA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:STE 29
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4595
Mailing Address - Country:US
Mailing Address - Phone:281-255-0000
Mailing Address - Fax:281-255-0550
Practice Address - Street 1:647 JAMES STREET
Practice Address - Street 2:SUITE 130
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4625
Practice Address - Country:US
Practice Address - Phone:281-255-0000
Practice Address - Fax:281-255-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60480174400000X
TXH9878207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ21247ZMedicare ID - Type Unspecified
CAF80776Medicare UPIN