Basic Information
| Provider Information | |||||||||
| NPI: | 1043622103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOLBERT | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | LAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11130 CHRISTUS HILLS | ||||||||
| Address2: | 2ND FLOOR, SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782513584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107039045 | ||||||||
| FaxNumber: | 2107039009 | ||||||||
| Practice Location | |||||||||
| Address1: | 8080 INDEPENDENCE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750254002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725969511 | ||||||||
| FaxNumber: | 9728678163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP10051254 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | R3010 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.