Provider Demographics
NPI:1386633691
Name:MEYER, LAWRENCE HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HOWARD
Last Name:MEYER
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 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-448-3392
Practice Address - Street 1:465 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-7888
Practice Address - Fax:501-745-4401
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1386633691OtherNPI
AR17429000000OtherQUALCHOICE QCA
AR127779001Medicaid
AR57297Medicare PIN
AR17429000000OtherQUALCHOICE QCA
AR54669Medicare ID - Type Unspecified