Provider Demographics
NPI:1730672411
Name:PERMEN, LAWRENCE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:PERMEN
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 1:25139 ALLURE AVE
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-8713
Mailing Address - Country:US
Mailing Address - Phone:541-935-0950
Mailing Address - Fax:
Practice Address - Street 1:25139 ALLURE AVE
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-8713
Practice Address - Country:US
Practice Address - Phone:541-935-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24169207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty