Provider Demographics
NPI:1922068691
Name:MATTHEWS, LAWRENCE W (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5262
Mailing Address - Country:US
Mailing Address - Phone:515-279-6424
Mailing Address - Fax:515-279-3237
Practice Address - Street 1:2103 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5262
Practice Address - Country:US
Practice Address - Phone:515-279-6424
Practice Address - Fax:515-279-3237
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1244400Medicaid
IA1922068691Medicaid
IA1922068691Medicaid
IAA01321Medicare UPIN
IAP00251307Medicare PIN
IAI15405Medicare PIN