Provider Demographics
NPI:1346399466
Name:LAWRENCE, JOHN FAIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FAIN
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2222 SANTA MONICA BOULEVARD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2308
Mailing Address - Country:US
Mailing Address - Phone:310-828-6001
Mailing Address - Fax:310-828-3152
Practice Address - Street 1:2222 SANTA MONICA BOULEVARD
Practice Address - Street 2:SUITE 403
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2308
Practice Address - Country:US
Practice Address - Phone:310-828-6001
Practice Address - Fax:310-828-3152
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9783207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G9783Medicare ID - Type Unspecified
A59001Medicare UPIN