Basic Information
| Provider Information | |||||||||
| NPI: | 1548621469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAURITA | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6767 LAKE WOODLANDS DR | ||||||||
| Address2: | STE F | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773822566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813641122 | ||||||||
| FaxNumber: | 2812102446 | ||||||||
| Practice Location | |||||||||
| Address1: | 6767 LAKE WOODLANDS DR STE F | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773822566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813641122 | ||||||||
| FaxNumber: | 2814193101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2016 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | T6293 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 282512 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207XS0114X | T6293 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 282512 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0000 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.