Provider Demographics
NPI:1750497384
Name:LAWRENCE, FREDERICK LOCKE III (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LOCKE
Last Name:LAWRENCE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:249 RISING FAWN TRL
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9261
Mailing Address - Country:US
Mailing Address - Phone:989-275-8565
Mailing Address - Fax:989-275-8746
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-7934
Practice Address - Country:US
Practice Address - Phone:989-275-8565
Practice Address - Fax:989-275-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIFL040301208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0107200022OtherBCBS
MIA79027Medicare UPIN
MI07200025012Medicare ID - Type Unspecified