Provider Demographics
NPI:1477792992
Name:VREDEVOE, LAWRENCE ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ARTHUR
Last Name:VREDEVOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 WILD RYE WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-4935
Mailing Address - Country:US
Mailing Address - Phone:805-542-9950
Mailing Address - Fax:805-781-8433
Practice Address - Street 1:1515 WILD RYE WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-4935
Practice Address - Country:US
Practice Address - Phone:805-542-9950
Practice Address - Fax:805-781-8433
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE32395207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology