Provider Demographics
NPI:1851345466
Name:LAWRENCE, WILLIE E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:E
Last Name:LAWRENCE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:T-509
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-276-4800
Mailing Address - Fax:816-523-1425
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:T-509
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-276-4800
Practice Address - Fax:816-523-1425
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8P45207RI0011X
KS0423881207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004219910OtherAETNA PPO
17894012OtherBLUE SHIELD OF KC HMO
431092652 A024OtherCHAMPUS TRICARE
0004219910OtherAETNA HMO
0004219910OtherAETNA
060042470OtherMEDICARE RAILROAD
17894012OtherPHP FREEDOM
17894012OtherBLUE SHIELD OF KC PPO
17894012OtherBLUE SHIELD OF KC PPO
060042470OtherMEDICARE RAILROAD