Provider Demographics
NPI:1134302912
Name:LAWRENCE CHRISTOPHER GAUS
Entity Type:Organization
Organization Name:LAWRENCE CHRISTOPHER GAUS
Other - Org Name:PROACTIVE FOOTWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-837-5777
Mailing Address - Street 1:7120 WIND ROW DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8625
Mailing Address - Country:US
Mailing Address - Phone:972-837-5777
Mailing Address - Fax:
Practice Address - Street 1:7120 WIND ROW DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8625
Practice Address - Country:US
Practice Address - Phone:972-837-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5854740001Medicare NSC