Provider Demographics
NPI:1447215249
Name:LAWRENCE, LARRY BRIT (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:BRIT
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 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-686-0207
Mailing Address - Fax:
Practice Address - Street 1:11111 RESEARCH BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5264
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-605-6396
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275257-10Medicaid
348487YMP3Medicare PIN
G47579Medicare UPIN