Provider Demographics
NPI:1215363676
Name:KLOCK, LAWRENCE EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:KLOCK
Suffix:JR
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 1:4115 S BELLGROVE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6185
Mailing Address - Country:US
Mailing Address - Phone:509-455-9721
Mailing Address - Fax:
Practice Address - Street 1:4115 S BELLGROVE LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6185
Practice Address - Country:US
Practice Address - Phone:509-455-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00010976207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease