Provider Demographics
NPI:1013098920
Name:LAWSON, CLYDE HARRIS (MD)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:HARRIS
Last Name:LAWSON
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 1:8234 S. ASHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5322
Mailing Address - Country:US
Mailing Address - Phone:773-874-1400
Mailing Address - Fax:773-874-9245
Practice Address - Street 1:8234 S. ASHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5322
Practice Address - Country:US
Practice Address - Phone:773-874-1400
Practice Address - Fax:773-874-9245
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060418207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060418Medicaid
IL367830Medicare PIN
IL036060418Medicaid