Provider Demographics
NPI:1740243914
Name:LAWSON, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:LAWSON
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 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:SUITE 499
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7405
Mailing Address - Country:US
Mailing Address - Phone:907-746-7771
Mailing Address - Fax:907-746-7798
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 499
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-746-7771
Practice Address - Fax:907-746-7798
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5678207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK371517932OtherTAX ID
AKMD4511Medicaid
AKMD4511Medicaid