Provider Demographics
NPI:1730120676
Name:SENFFNER, LAWRENCE ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ANTHONY
Last Name:SENFFNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3798 JANES RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4753
Mailing Address - Country:US
Mailing Address - Phone:707-822-2432
Mailing Address - Fax:707-822-6301
Practice Address - Street 1:3798 JANES RD
Practice Address - Street 2:SUITE 20
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4753
Practice Address - Country:US
Practice Address - Phone:707-822-2432
Practice Address - Fax:707-822-6301
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G176510Medicaid
CA00G176510Medicaid
CAWG176510Medicare ID - Type Unspecified