Provider Demographics
NPI:1710051172
Name:CARREON, LAWRENCE H (PAC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:CARREON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:HERNANDEZ
Other - Last Name:CARREON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:MSC06 3870 1 UNIV OF NM
Mailing Address - Street 2:UNM STUDENT HEALTH CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-277-3136
Mailing Address - Fax:505-277-5668
Practice Address - Street 1:MSC06 3870 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:UNM STUDENT HEALTH CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:505-277-5668
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86PA061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
90447Medicare UPIN