Provider Demographics
NPI:1588614705
Name:BJORN Y. LAWSON DPM, LLC
Entity Type:Organization
Organization Name:BJORN Y. LAWSON DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BJORN
Authorized Official - Middle Name:YNGVAR
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-926-3873
Mailing Address - Street 1:1121 S GILBERT RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5235
Mailing Address - Country:US
Mailing Address - Phone:480-926-3873
Mailing Address - Fax:480-926-1600
Practice Address - Street 1:1121 S GILBERT RD
Practice Address - Street 2:SUITE #102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5235
Practice Address - Country:US
Practice Address - Phone:480-926-3873
Practice Address - Fax:480-926-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ638213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ981862Medicaid
AZ981862Medicaid
AZ5609580001Medicare NSC