Provider Demographics
NPI:1578601423
Name:BIRNBAUM, LAWRENCE MORTON (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAWRENCE
Middle Name:MORTON
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:MORTON
Other - Last Name:BIRNBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1929 TRUXTUN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5021
Mailing Address - Country:US
Mailing Address - Phone:661-322-2025
Mailing Address - Fax:661-322-5252
Practice Address - Street 1:1929 TRUXTUN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5021
Practice Address - Country:US
Practice Address - Phone:661-322-2025
Practice Address - Fax:661-322-5252
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC36207Medicare UPIN
CA00GMedicare ID - Type Unspecified