Provider Demographics
NPI:1710988449
Name:HOUSMAN, LAWRENCE R (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:HOUSMAN
Suffix:
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:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6249
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:ORTHOPAEDIC BUILDING, 1ST FLOOR
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-784-6200
Practice Address - Fax:520-784-6249
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10715207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200S93Medicaid
C99665Medicare UPIN
AZ200S93Medicaid
AZZWMBCJ14Medicare PIN