Provider Demographics
NPI:1164453338
Name:LAWRENCE D. DORR, M.D., INC.
Entity Type:Organization
Organization Name:LAWRENCE D. DORR, M.D., INC.
Other - Org Name:LAWRENCE D. DORR, M.D., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-2280
Mailing Address - Street 1:637 SOUTH LUCAS AVE 1ST FL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017
Mailing Address - Country:US
Mailing Address - Phone:213-977-2280
Mailing Address - Fax:213-202-7225
Practice Address - Street 1:637 SOUTH LUCAS AVE 1ST FL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-977-2280
Practice Address - Fax:213-202-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI40112Medicare UPIN