Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2015029582 | MO |
N | 207Q00000X | Family Doctor | LL33845 | SC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2015029582 | MO |
NPI | 1306133129 |
---|---|
Provider Name | Andrew J Lawrence |
First Address | Cape Girardeau, MO 63701-4556 |
Second Address | Cape Girardeau, MO 63701-4556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 14/01/2019 |