Provider Demographics
NPI:1922217124
Name:CANFIELD, LAWRENCE RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RUSSELL
Last Name:CANFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:66 AVENIDA ALDEA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9449
Mailing Address - Country:US
Mailing Address - Phone:505-795-7111
Mailing Address - Fax:505-795-7112
Practice Address - Street 1:66 AVENIDA ALDEA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9449
Practice Address - Country:US
Practice Address - Phone:505-795-7111
Practice Address - Fax:505-795-7112
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM98-233207Q00000X, 207KI0005X, 207ZI0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH38464Medicare UPIN