Provider Demographics
NPI:1952672453
Name:LAWRENCE, GALE (MD)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6208
Mailing Address - Country:US
Mailing Address - Phone:156-259-6424
Mailing Address - Fax:156-259-6192
Practice Address - Street 1:1600 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6208
Practice Address - Country:US
Practice Address - Phone:156-259-6424
Practice Address - Fax:156-259-6192
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA0546542Medicare UPIN