Basic Information
| Provider Information | |||||||||
| NPI: | 1871854885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNDERWOOD | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | FITZGERALD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7909 FREDERICKSBURG RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106144544 | ||||||||
| FaxNumber: | 2106793936 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 MCCULLOUGH AVE STE 270 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104747020 | ||||||||
| FaxNumber: | 2106793733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 208600000X | BP10043376 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208800000X | R3448 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.