Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | ME61088 | FL |
NPI | 1861489692 |
---|---|
Provider Name | Sandra M Lawrence |
First Address | Boca Raton, FL 33497-0845 |
Second Address | Boca Raton, FL 33428-1705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 17/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255036900 | (05) | FL |
G80821 | (02) |