Provider Demographics
NPI:1619955457
Name:GESS, LAWRENCE WILLIAM JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:GESS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 STARRY CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1956
Mailing Address - Country:US
Mailing Address - Phone:817-294-2504
Mailing Address - Fax:
Practice Address - Street 1:2364 HIGHWAY 287 N
Practice Address - Street 2:SUITE 115
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9208
Practice Address - Country:US
Practice Address - Phone:817-539-2214
Practice Address - Fax:817-539-2254
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00012363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3312191Medicaid
TX3312191Medicaid
TX8F24512Medicare PIN
TXQ51485Medicare UPIN