Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 29467 | IA |
N | 208600000X | Surgeon | 29467 | IA |
Y | 2086S0120X | Pediatric Surgery | S8332 | TX |
NPI | 1164423265 |
---|---|
Provider Name | John P Lawrence |
First Address | El Paso, TX 79905-1613 |
Second Address | El Paso, TX 79905-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101576 | (05) | IA |
12174 | WELLMARK BCBS (01) | IA |
F65338 | (02) |