Provider Demographics
NPI:1275752677
Name:BISTRONG, LAWRENCE DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DEAN
Last Name:BISTRONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-679-3513
Mailing Address - Fax:916-679-3563
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2867
Practice Address - Country:US
Practice Address - Phone:916-679-3590
Practice Address - Fax:916-482-3647
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA91686207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16303Medicare UPIN
CAAR143ZMedicare PIN