Provider Demographics
NPI:1497948756
Name:LAWRENCE W SERIF, DO A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE W SERIF, DO A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SERIF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-416-4511
Mailing Address - Street 1:PO BOX 2110
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2110
Mailing Address - Country:US
Mailing Address - Phone:760-416-4511
Mailing Address - Fax:760-416-4512
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:W201
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-416-4511
Practice Address - Fax:760-416-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06508ZMedicare PIN
CAE69197Medicare UPIN