Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | M5854 | ID |
NPI | 1144269747 |
---|---|
Provider Name | Dr. Stewart Lawrence |
First Address | Boise, ID 83704-8855 |
Second Address | Boise, ID 83704-8855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 06/08/2007 |