Provider Demographics
NPI:1275699563
Name:LAWSON, IAN B (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:B
Last Name:LAWSON
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 1:1550 S UNION AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1946
Mailing Address - Country:US
Mailing Address - Phone:253-301-5150
Mailing Address - Fax:
Practice Address - Street 1:1550 S UNION AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1946
Practice Address - Country:US
Practice Address - Phone:253-301-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035040207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8210189Medicaid
WA162782OtherDEPT OF LABOR & INDUSTRIE
WA1301548002OtherCIGNA
WALA2374OtherREGENCE BLUE SHIELD
WAG50712Medicare UPIN
WAG50712Medicare UPIN