Provider Demographics
NPI:1356457709
Name:LAWRENCE, FRANK M (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:M
Last Name:LAWRENCE
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0400
Mailing Address - Country:US
Mailing Address - Phone:479-968-7302
Mailing Address - Fax:479-968-5131
Practice Address - Street 1:1700 W B ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2704
Practice Address - Country:US
Practice Address - Phone:479-968-7302
Practice Address - Fax:479-968-5131
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD04724Medicare UPIN
AR53067Medicare ID - Type Unspecified