Provider Demographics
NPI:1568457141
Name:ALTER, LAWRENCE J (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:ALTER
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 1:7200 STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4132
Mailing Address - Country:US
Mailing Address - Phone:972-401-4940
Mailing Address - Fax:972-401-4930
Practice Address - Street 1:7200 STATE HIGHWAY 161
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4132
Practice Address - Country:US
Practice Address - Phone:817-303-4521
Practice Address - Fax:972-401-4930
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6258208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122446103Medicaid
TX122446108Medicaid
TX122446106Medicaid
TX122446107OtherMEDICAID OTHER
TX122446105Medicaid
TX122446104Medicaid
TXB20879Medicare UPIN
TX122446108Medicaid
TX122446106Medicaid
TX83Z610Medicare PIN