Provider Demographics
NPI:1639169345
Name:LAWRENCE, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:LAWRENCE
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 22562
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-2562
Mailing Address - Country:US
Mailing Address - Phone:928-758-9500
Mailing Address - Fax:928-758-9575
Practice Address - Street 1:3015 HIGHWAY 95
Practice Address - Street 2:SUITE 106
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4334
Practice Address - Country:US
Practice Address - Phone:928-758-9500
Practice Address - Fax:928-758-9575
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19407207RP1001X
CAA44334207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ295883Medicaid
CAXYP182890Medicaid
E83141Medicare UPIN
AZMD19407AMedicare ID - Type Unspecified
AZ295883Medicaid
CAXYP182890Medicaid