Provider Demographics
NPI:1366632879
Name:LAWRENCE, WILLIAM WESLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:LAWRENCE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2501 MAIL SERVICE CTR
Mailing Address - Street 2:NC DIVISION OF MEDICAL ASSISTANCE
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-2500
Mailing Address - Country:US
Mailing Address - Phone:919-855-4100
Mailing Address - Fax:919-733-6608
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3048
Practice Address - Country:US
Practice Address - Phone:919-220-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9700630208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907790Medicaid
NC5907790Medicaid