Provider Demographics
NPI:1407847163
Name:BRECKER, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:BRECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1110 E MISSOURI AVE
Mailing Address - Street 2:600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2707
Mailing Address - Country:US
Mailing Address - Phone:602-277-4455
Mailing Address - Fax:602-277-9654
Practice Address - Street 1:1110 E MISSOURI AVE
Practice Address - Street 2:600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2707
Practice Address - Country:US
Practice Address - Phone:602-277-4455
Practice Address - Fax:602-277-9654
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ7945207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071627735OtherPALMETTO GBA RAILROAD MED
AZ245979OtherAHCCCS
AZAZ0053690OtherBLUE CROSS BLUE SHIELD
AZ245979OtherAHCCCS