Provider Demographics
NPI:1275063521
Name:EDE, LAWRENCE E (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:EDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:605 S CONROE MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4722
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:936-539-3635
Practice Address - Street 1:227 STATE HIGHWAY 75 N STE 130
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3171
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-291-0746
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR8730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3870701-02Medicaid
TXFE7881421OtherDEA