Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MT181572 | PA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD427503 | PA |
NPI | 1033279690 |
---|---|
Provider Name | John Todd Rutter Lawrence |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100743887-0029 | (05) | PA |