Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G32240 | CA |
Y | 208600000X | Surgeon | G32240 | CA |
N | 2086S0129X | Vascular Surgeon | G32240 | CA |
NPI | 1164560348 |
---|---|
Provider Name | Dr. Randolph Schuyler Lawrence |
First Address | Templeton, CA 93465-9711 |
Second Address | Templeton, CA 93465-9711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 06/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91420 | (02) | CA |