Provider Demographics
NPI:1609130301
Name:DEVOLLD, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DEVOLLD
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:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-658-1511
Mailing Address - Fax:
Practice Address - Street 1:2503 S GREGG ST
Practice Address - Street 2:UNIT C
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6553
Practice Address - Country:US
Practice Address - Phone:325-658-1511
Practice Address - Fax:325-481-2266
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2012-0516207Q00000X
TXQ5172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine