Provider Demographics
NPI:1851393813
Name:COSNER, LAWRENCE N JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:N
Last Name:COSNER
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1111 N. CHINA LAKE BLVD SUITE 190
Mailing Address - Street 2:RIDGECREST RURAL HEALTH CLINIC
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-499-3854
Mailing Address - Fax:760-499-3870
Practice Address - Street 1:1111 N. CHINA LAKE BLVD SUITE 190
Practice Address - Street 2:RIDGECREST RURAL HEALTH CLINIC
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555
Practice Address - Country:US
Practice Address - Phone:760-499-3855
Practice Address - Fax:760-499-3870
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG50371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G503710OtherBLUE SHIELD
CA00G503710Medicaid
00G503710OtherCOMMERCIAL INS.
0616650001OtherDME
110039740OtherRAILROAD MEDICARE
182651OtherAHI HEALTHLINK
CA0103OtherJOHN DEERE
93555B097OtherTRIWEST/TRICARE
00G503710OtherBLUE CROSS
00G503710OtherBLUE CROSS
00G503710OtherBLUE SHIELD
00G503710OtherCOMMERCIAL INS.
00G503710Medicare ID - Type Unspecified