Provider Demographics
NPI:1235261827
Name:LAWRENCE, LARRY DOUGLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DOUGLAS
Last Name:LAWRENCE
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 1:3500 ARENDELL ST
Mailing Address - Street 2:CARTERET GENERAL HOSPITAL
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2901
Mailing Address - Country:US
Mailing Address - Phone:252-808-6030
Mailing Address - Fax:
Practice Address - Street 1:1111 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6241
Practice Address - Country:US
Practice Address - Phone:541-732-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00008207R00000X, 208M00000X
METD171105207R00000X
ORMD184500208M00000X
MEMD22370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC145CNOtherBCBSNC
NC5907104Medicaid
NC5907104Medicaid
NC2067184Medicare PIN