Provider Demographics
NPI:1679537948
Name:FROOD, LAWRENCE RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAYMOND
Last Name:FROOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7424 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8120
Mailing Address - Country:US
Mailing Address - Phone:253-841-4353
Mailing Address - Fax:251-581-5698
Practice Address - Street 1:222 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3754
Practice Address - Country:US
Practice Address - Phone:253-841-4353
Practice Address - Fax:253-581-5698
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000271422085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8117236Medicaid
WA74121OtherL&I
WAE53887Medicare UPIN
WA74121OtherL&I