Provider Demographics
NPI:1225070253
Name:LAWRENCE, TRACY NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:NORMAN
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:27437 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1817
Mailing Address - Country:US
Mailing Address - Phone:661-263-8669
Mailing Address - Fax:661-263-8669
Practice Address - Street 1:18321 CLARK ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3501
Practice Address - Country:US
Practice Address - Phone:818-708-5170
Practice Address - Fax:818-705-2595
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73510207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A735100Medicaid
CAWA73510DMedicare PIN
CA00A735100Medicaid
CAWA73510Medicare PIN