Provider Demographics
NPI:1023027182
Name:ALDER, LAWRENCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:ALDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6455
Mailing Address - Country:US
Mailing Address - Phone:830-257-5500
Mailing Address - Fax:830-331-2475
Practice Address - Street 1:144 FAIRWAY DR STE A
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6456
Practice Address - Country:US
Practice Address - Phone:830-257-5500
Practice Address - Fax:830-257-5501
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-11-04
Deactivation Date:2019-06-14
Deactivation Code:
Reactivation Date:2019-06-19
Provider Licenses
StateLicense IDTaxonomies
TXK7967207R00000X, 207R00000X
AL30793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FG368OtherBCBS PROVIDER ID NUMBER
TXK7967OtherTEXAS MEDICAL LICENSE
TX452845YU5KMedicare UPIN
TX00708LMedicare PIN
TXG92254Medicare UPIN
FLEZ038YMedicare PIN