Provider Demographics
NPI:1902826688
Name:LAWRENCE, RICHARD B III (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:LAWRENCE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:6457 DARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4406
Mailing Address - Country:US
Mailing Address - Phone:817-994-0235
Mailing Address - Fax:817-377-2958
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3832
Practice Address - Country:US
Practice Address - Phone:214-750-6110
Practice Address - Fax:214-750-5665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXMDE2671204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80X961Medicare ID - Type Unspecified
TXC18201Medicare UPIN