Provider Demographics
NPI:1386674935
Name:LAWSON, JOHN W R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W R
Last Name:LAWSON
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 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 680
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-912-8400
Mailing Address - Fax:817-912-8410
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 680
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-912-8400
Practice Address - Fax:817-912-8410
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1460207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104769803Medicaid
TX104769806Medicaid
TX104769805Medicaid
TX104769804Medicaid
TX104769807Medicaid
TX8CX373OtherBCBSTX
TX060065690Medicare PIN
TX104769807Medicaid
TX8CX373OtherBCBSTX
TX104769806Medicaid
TX104769803Medicaid
TXTXB138545Medicare PIN
TX060065718Medicare PIN
TXE33688Medicare UPIN
TX104769804Medicaid
TX8740N5Medicare PIN