Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 0101-018187 | VA |
NPI | 1457302952 |
---|---|
Provider Name | Dr. Walter (none) Lawrence JR. |
First Address | Richmond, VA 23226-3118 |
Second Address | Richmond, VI 23298-0011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |