Provider Demographics
NPI:1689938656
Name:CONOVER, LAWRENCE CHRISTOPHER (PAC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CHRISTOPHER
Last Name:CONOVER
Suffix:
Gender:M
Credentials:PAC
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-6000
Mailing Address - Fax:541-732-6005
Practice Address - Street 1:1698 E MCANDREWS RD STE 400
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5590
Practice Address - Country:US
Practice Address - Phone:541-732-6000
Practice Address - Fax:541-732-6005
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003269363A00000X
ORPA172028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant