Provider Demographics
NPI:1467405050
Name:TERUEL, LAWRENCE NUNEZ (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:NUNEZ
Last Name:TERUEL
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:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-0093
Mailing Address - Country:US
Mailing Address - Phone:520-458-4919
Mailing Address - Fax:
Practice Address - Street 1:155 CALLE PORTAL
Practice Address - Street 2:SUITE 600
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-458-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34998207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17563Medicare UPIN