Provider Demographics
NPI:1235238130
Name:LAWLER, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
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 1:7100 REDWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4110
Mailing Address - Country:US
Mailing Address - Phone:415-492-1600
Mailing Address - Fax:415-492-1688
Practice Address - Street 1:7100 REDWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:415-492-1600
Practice Address - Fax:415-492-1688
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69218207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A692180Medicare PIN