Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 30943 | MA |
NPI | 1477506541 |
---|---|
Provider Name | Michael Lawrence |
First Address | Brockton, MA 02301-2866 |
Second Address | Brockton, MA 02301-2866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 20/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188301 | (05) | MA |
B73516 | (02) | MA |