Provider Demographics
NPI:1467482018
Name:LAWRENCE, BRUCE DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9095 S SAGINAW
Mailing Address - Street 2:#17
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-429-0911
Mailing Address - Fax:
Practice Address - Street 1:8020 DAVISON RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2029
Practice Address - Country:US
Practice Address - Phone:810-578-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008624207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3166342Medicaid
MIM06280001Medicare PIN
MI3166342Medicaid