Provider Demographics
NPI:1073548855
Name:GEORGE, LAWRENCE MONROE (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MONROE
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:211 CARTER ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4303
Practice Address - Country:US
Practice Address - Phone:870-423-3338
Practice Address - Fax:870-423-7330
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-3465208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-3465OtherLICENSE
AR5M428OtherAR BLUE SHIELD #
AR126625001Medicaid
MO208778200Medicaid
E35076Medicare UPIN
ARE-3465OtherLICENSE