Basic Information
| Provider Information | |||||||||
| NPI: | 1720061781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11801 SOUTH FREEWAY | ||||||||
| Address2: | PO BOX 6337 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175685456 | ||||||||
| FaxNumber: | 8175681296 | ||||||||
| Practice Location | |||||||||
| Address1: | 11801 SOUTH FREEWAY | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175685456 | ||||||||
| FaxNumber: | 8175681296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 10/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | K9101 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0022EJ | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 029998402 | 01 | TX | SUPERIOR HEALTH CHIPS | OTHER | 029998402 | 05 | TX | MEDICAID | 930973104 | 01 | TX | HUMANA/MILITARY-TRICARE | OTHER |