Provider Demographics
NPI:1528033958
Name:TEPPER, LAWRENCE A (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:TEPPER
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 1:21000 PORTOFINO CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1262
Mailing Address - Country:US
Mailing Address - Phone:561-848-1011
Mailing Address - Fax:561-848-9166
Practice Address - Street 1:3426 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4224
Practice Address - Country:US
Practice Address - Phone:305-296-0021
Practice Address - Fax:561-848-9166
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4845207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528033958OtherNPI
FL063922200Medicaid
FL063922200Medicaid