Provider Demographics
NPI:1083689277
Name:TAMBURINO, LAWRENCE EDWARD (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:TAMBURINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SERVICE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2401
Mailing Address - Country:US
Mailing Address - Phone:601-824-4700
Mailing Address - Fax:601-824-4800
Practice Address - Street 1:103 SERVICE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2401
Practice Address - Country:US
Practice Address - Phone:601-824-4700
Practice Address - Fax:601-824-4800
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80160213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120860Medicaid
MS00120860Medicaid
U71448Medicare UPIN
MS480033555Medicare PIN
434827001Medicare NSC