Provider Demographics
NPI:1932472198
Name:DUNLAP, LAWRENCE BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BRUCE
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1669
Mailing Address - Country:US
Mailing Address - Phone:541-686-6745
Mailing Address - Fax:
Practice Address - Street 1:2865 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1669
Practice Address - Country:US
Practice Address - Phone:541-686-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08026207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR263624Medicaid
OR263624Medicaid