Provider Demographics
NPI:1235168188
Name:LAWRENCE, AUGUSTINE HICKS (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:HICKS
Last Name:LAWRENCE
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 1:1412 SW 43RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4803
Mailing Address - Country:US
Mailing Address - Phone:425-271-4910
Mailing Address - Fax:425-264-1041
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4803
Practice Address - Country:US
Practice Address - Phone:425-271-4910
Practice Address - Fax:425-264-1041
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037577207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8243818Medicaid
WA8243818Medicaid
WA8851102Medicare ID - Type Unspecified