Provider Demographics
NPI:1093865362
Name:LAWRENCE PLASTIC SURGERY, P.A.
Entity Type:Organization
Organization Name:LAWRENCE PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-843-7677
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-843-7677
Mailing Address - Fax:785-843-1657
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-843-7677
Practice Address - Fax:785-843-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25277208200000X
KS04-29112208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS22872019OtherBCBS OF KANSAS CITY
KS16889OtherBCBS