Provider Demographics
NPI:1659455095
Name:LAWRENCE, JAY A (DO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 SHERIDAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2901
Mailing Address - Country:US
Mailing Address - Phone:360-385-5444
Mailing Address - Fax:360-385-5352
Practice Address - Street 1:1010 SHERIDAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2901
Practice Address - Country:US
Practice Address - Phone:360-385-5444
Practice Address - Fax:360-385-5352
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001417208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083799Medicaid
WA1083799Medicaid
WAF58181Medicare UPIN