Provider Demographics
NPI:1093704694
Name:CLEWNER, LAWRENCE MAXWELL (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MAXWELL
Last Name:CLEWNER
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 1:1701 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1909
Mailing Address - Country:US
Mailing Address - Phone:561-395-5666
Mailing Address - Fax:561-368-0883
Practice Address - Street 1:1701 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1909
Practice Address - Country:US
Practice Address - Phone:561-395-5666
Practice Address - Fax:561-368-0883
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70597207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0872430001Medicare NSC
FL49276ZMedicare ID - Type Unspecified
G08326Medicare UPIN