Provider Demographics
NPI:1578852711
Name:LAWRENCE, RYAN NEAL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NEAL
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ARBROOK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3176
Mailing Address - Country:US
Mailing Address - Phone:254-498-1601
Mailing Address - Fax:
Practice Address - Street 1:400 W ARBROOK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3176
Practice Address - Country:US
Practice Address - Phone:254-498-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1965213E00000X
OH59. 000236213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB133633OtherMEDICARE PTAN