Provider Demographics
NPI:1528383130
Name:LAWRENCE, CONRAD M (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:480-351-2850
Mailing Address - Fax:480-351-2851
Practice Address - Street 1:2080 W SOUTHERN AVE
Practice Address - Street 2:BLDG. B10
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7455
Practice Address - Country:US
Practice Address - Phone:480-351-2850
Practice Address - Fax:480-351-2851
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
AZ48947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
031918OtherMEDICARE
Z168007OtherMEDICARE