Provider Demographics
NPI:1639117948
Name:VANMETER, LAWRENCE RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:VANMETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:VAN METER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:STE 285
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-566-8179
Mailing Address - Fax:888-565-6545
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:STE 285
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-566-8179
Practice Address - Fax:888-565-6545
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24714Medicare UPIN
CAWA26072CMedicare ID - Type Unspecified