Provider Demographics
NPI:1235576752
Name:LAWING, JUSTIN SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SCOTT
Last Name:LAWING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1530
Mailing Address - Country:US
Mailing Address - Phone:913-945-9700
Mailing Address - Fax:913-945-9707
Practice Address - Street 1:6420 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119
Practice Address - Country:US
Practice Address - Phone:913-945-9700
Practice Address - Fax:913-945-9707
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9408100207Q00000X
MO2016013406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01726301OtherRR MEDICARE
MOJ61000021Medicare PIN