Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 3902000 | WV |
NPI | 1023540630 |
---|---|
Provider Name | Dr. Jesse Lawrence |
First Address | Morgantown, WV 26508 |
Second Address | Morgantown, WV 26506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2017 |
Last Update Date | 14/04/2017 |