Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 34430 | IA |
NPI | 1083698088 |
---|---|
Provider Name | David Michael Lawrence |
First Address | Cedar Rapids, IA 52406-3178 |
Second Address | Cedar Rapids, IA 52403-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39192 | BLUE CROSS BLIUE SHIELD (01) | IA |
I24214 | (02) | IA |