Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MDE2671 | TX |
NPI | 1902826688 |
---|---|
Provider Name | Dr. Richard B Lawrence III |
First Address | Fort Worth, TX 76116-4406 |
Second Address | Dallas, TX 75231-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C18201 | (02) | TX |