Provider Demographics
NPI:1417386400
Name:THOMAS, LAWRENCE T JR
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:T
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 W VEREDA VERDE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-8001
Mailing Address - Country:US
Mailing Address - Phone:480-235-3456
Mailing Address - Fax:520-578-3901
Practice Address - Street 1:1220 W SAND DUNE DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5615
Practice Address - Country:US
Practice Address - Phone:480-235-3456
Practice Address - Fax:520-578-3901
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10718171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator