Provider Demographics
NPI:1063688869
Name:LAWSON, DONALD RIDGLEY
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RIDGLEY
Last Name:LAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 WEEKS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-5251
Mailing Address - Country:US
Mailing Address - Phone:352-754-9446
Mailing Address - Fax:352-754-9446
Practice Address - Street 1:9480 WEEKS DR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-5251
Practice Address - Country:US
Practice Address - Phone:352-754-9446
Practice Address - Fax:352-754-9446
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL451499800Medicaid