Provider Demographics
NPI:1093819252
Name:STUTTE, LAWRENCE DEAN (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DEAN
Last Name:STUTTE
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:IOWA PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76367-1639
Mailing Address - Country:US
Mailing Address - Phone:940-592-4141
Mailing Address - Fax:940-592-4842
Practice Address - Street 1:310 W ALAMEDA
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367-1600
Practice Address - Country:US
Practice Address - Phone:940-592-4141
Practice Address - Fax:940-592-4842
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101776601Medicaid
C22386Medicare UPIN
TX101776601Medicaid