Provider Demographics
NPI:1154466571
Name:LAWLER, CORY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:JOHN
Last Name:LAWLER
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 1:1700 W. HIBISCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:MLEBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-724-8193
Mailing Address - Fax:321-727-9479
Practice Address - Street 1:1700 W. HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MLEBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-724-8193
Practice Address - Fax:321-727-9479
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56165Medicare UPIN
FL56165Medicare ID - Type Unspecified