Basic Information
| Provider Information | |||||||||
| NPI: | 1760772859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAXTON | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 TRINITY ST STOP Z0200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787121850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8338822737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 TRINITY ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787121765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124955000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD20150176 | NM | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 20180142 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1760772859 | 05 | NM | MEDICAID |