Provider Demographics
NPI:1124017850
Name:SOLBERG, LAWRENCE ARTHUR JR (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ARTHUR
Last Name:SOLBERG
Suffix:JR
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 COOPERS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-8436
Mailing Address - Country:US
Mailing Address - Phone:904-223-3146
Mailing Address - Fax:
Practice Address - Street 1:3827 COOPERS LAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-8436
Practice Address - Country:US
Practice Address - Phone:904-223-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60970207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830001042OtherRAILROAD MEDICARE
FL14296OtherBLUECROSS/BLUESHIELD
FL371817400Medicaid
FL14296ZMedicare PIN
FLD81591Medicare UPIN