Provider Demographics
NPI:1497718704
Name:WASPE, LAWRENCE EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:WASPE
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 1:446 SELBY LN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-6346
Mailing Address - Country:US
Mailing Address - Phone:209-480-3450
Mailing Address - Fax:209-529-6610
Practice Address - Street 1:1401 SPANOS COURT
Practice Address - Street 2:#203
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-522-0600
Practice Address - Fax:209-491-0116
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57417207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G574170Medicaid
CA00G574170Medicaid