Divine, Laura Michelle

Divine, Laura Michelle is an individual health care provider with primary practice located at 3410 Worth St Ste 400 , Dallas TX 75246-2092. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gynecologic Oncology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Gynecologic Oncology is her primary health care specialty. Divine, Laura Michelle can be contacted via phone (214) 370-1300.

Contact Information

Primary practice address
3410 Worth St Ste 400 Dallas TX 75246-2092
Phone: (214) 370-1300
Fax: (214) 370-1313
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecologic Oncology 207VX0201X R3314 Texas
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1255659173
LBN Legal business name Divine, Laura Michelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2010
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255659173 NPPES
Texas MEDICAID 372957602

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