Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A69218 | CA |
NPI | 1235238130 |
---|---|
Provider Name | Mark S Lawler |
First Address | Novato, CA 94945-4110 |
Second Address | Novato, CA 94945-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 22/10/2018 |