Provider Demographics
NPI:1003911900
Name:LAWSON, ROBERT GUSTAVE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GUSTAVE
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S ESCONDIDO BLVD
Mailing Address - Street 2:PMB #144
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4116
Mailing Address - Country:US
Mailing Address - Phone:760-715-3656
Mailing Address - Fax:760-233-1265
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 300
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-485-1494
Practice Address - Fax:858-485-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3710213EP1101X, 213ES0000X, 213ES0103X, 213ES0131X
CARHD 134777213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37100Medicaid
CA480018837OtherRAILROAD MEDICARE
CAT97055Medicare UPIN
CAE3710Medicare ID - Type Unspecified
CAE3710BMedicare ID - Type Unspecified