Provider Demographics
NPI:1679528103
Name:WEPRIN, LAWRENCE SCOTT IV (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:SCOTT
Last Name:WEPRIN
Suffix:IV
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 1:7150 N. PRES. GEORGE BUSH HWY
Mailing Address - Street 2:#202
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044
Mailing Address - Country:US
Mailing Address - Phone:972-414-0408
Mailing Address - Fax:972-495-9084
Practice Address - Street 1:7150 N. PRES. GEORGE BUSH HWY
Practice Address - Street 2:#202
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044
Practice Address - Country:US
Practice Address - Phone:972-414-0408
Practice Address - Fax:972-495-9084
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0184207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110212104Medicaid
TX110212102Medicaid
TX8BU520OtherBCBS
TX8BU520OtherBCBS
TX110212102Medicaid
TX1114540001Medicare NSC
TXC23348Medicare UPIN
TXP00709061Medicare PIN