Provider Demographics
NPI:1073523791
Name:LAWYER, CARL H (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:H
Last Name:LAWYER
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 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-429-8150
Practice Address - Street 1:700 W 800 N
Practice Address - Street 2:SUITE 220
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6301
Practice Address - Country:US
Practice Address - Phone:801-354-8205
Practice Address - Fax:801-354-8206
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087801207R00000X, 207RP1001X
MO2004030793207RP1001X
UT7484405-1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020057300OtherBLACK LUNG
IL036087801OtherIL STATE LICENSE
IL077831OtherHEALTH ALLIANCE
IL08421024OtherBC/BS
IL290014322OtherRR MEDICARE PIN
IL371363944OtherIRS TAX ID
IL036087801Medicaid
IL133586700OtherACS-OWCP
IL14D0949277OtherCLIA
IL468846OtherHEALTHLINK
IL6394POtherCATERPILLAR
ILCD7143OtherRR MEDICARE GROUP#
IL170770OtherPERSONAL CARE
IL371363944OtherIRS TAX ID
IL209581Medicare ID - Type UnspecifiedIL MEDICARE LOC 12 GROUP#
IL036087801Medicaid
IL14D0949277OtherCLIA
IL133586700OtherACS-OWCP