Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP00001467 | WA |
N | 2084N0402X | Child Neurologist | OP00001467 | WA |
NPI | 1275693343 |
---|---|
Provider Name | Dr. Lawrence Lavine |
First Address | Lakewood, WA 98498-1163 |
Second Address | Lakewood, WA 98498-1163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11110197 | (05) | WA |
D32411 | (02) |