Provider Demographics
NPI:1407874076
Name:LAWRENCE, SCOTT ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
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 1:1361 WENNER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7918
Mailing Address - Country:US
Mailing Address - Phone:218-396-6500
Mailing Address - Fax:218-396-6504
Practice Address - Street 1:1361 WENNER RD
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7918
Practice Address - Country:US
Practice Address - Phone:218-396-6500
Practice Address - Fax:218-396-6504
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98451Medicare UPIN
MN080014094Medicare PIN