Provider Demographics
NPI:1467574475
Name:DRS DAVID & DEBRA LAWRENCE
Entity Type:Organization
Organization Name:DRS DAVID & DEBRA LAWRENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-596-0823
Mailing Address - Street 1:85 BEACH ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2717
Mailing Address - Country:US
Mailing Address - Phone:401-596-0823
Mailing Address - Fax:401-596-2960
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:BLDG C
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-596-0823
Practice Address - Fax:401-596-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073547162OtherINDIVIDUAL NPI FOR DEBRA CRIDER LAWRENCE
1891729976OtherINDIVIDUAL NPI FOR DAVID LAWRENCE
1891729976OtherINDIVIDUAL NPI FOR DAVID LAWRENCE
CT=========001OtherTRICARE
CTCJ6759Medicare PIN
1891729976OtherINDIVIDUAL NPI FOR DAVID LAWRENCE