Provider Demographics
NPI:1114905809
Name:WILL, LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:WILL
Suffix:
Gender:M
Credentials:DO
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 628
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-0628
Mailing Address - Country:US
Mailing Address - Phone:620-326-3353
Mailing Address - Fax:620-326-2032
Practice Address - Street 1:1323 N A ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4350
Practice Address - Country:US
Practice Address - Phone:620-326-3353
Practice Address - Fax:620-326-2032
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-16918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH52394Medicare UPIN