Provider Demographics
NPI:1710901616
Name:LAWRENCE, BRUCE PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:PETER
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2710 TELEGRAPH AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1771
Mailing Address - Country:US
Mailing Address - Phone:510-465-2500
Mailing Address - Fax:510-465-2502
Practice Address - Street 1:445 30TH ST
Practice Address - Street 2:2ND FLR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3301
Practice Address - Country:US
Practice Address - Phone:510-465-2500
Practice Address - Fax:510-465-2502
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG24736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G247360Medicaid
CAA42364Medicare UPIN
00G247360Medicare ID - Type Unspecified