Provider Demographics
NPI:1073521282
Name:LAWRENCE, LARRY HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:HERBERT
Last Name:LAWRENCE
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 1:3818 FRIENDLY HOPE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6989
Mailing Address - Country:US
Mailing Address - Phone:870-910-5290
Mailing Address - Fax:870-910-5290
Practice Address - Street 1:3818 FRIENDLY HOPE RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-6989
Practice Address - Country:US
Practice Address - Phone:870-910-5290
Practice Address - Fax:870-910-5290
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118446001Medicaid
AR54354OtherABCBS PROVIDER NUMBER
AR54354Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
AR118446001Medicaid