Provider Demographics
NPI:1558379461
Name:GASSNER, LAWRENCE P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:GASSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18404 N TATUM BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1509
Mailing Address - Country:US
Mailing Address - Phone:602-971-5500
Mailing Address - Fax:602-944-0504
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:STE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1509
Practice Address - Country:US
Practice Address - Phone:602-971-5500
Practice Address - Fax:602-944-0504
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ19150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110213982OtherRR MEDICARE ID
AZ19150OtherLICENSE
110213982OtherRR MEDICARE ID
E90081Medicare UPIN