Provider Demographics
NPI:1013153758
Name:DURISCH, LAWRENCE L JR (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:DURISCH
Suffix:JR
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 1:91 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1767
Mailing Address - Country:US
Mailing Address - Phone:770-536-9191
Mailing Address - Fax:
Practice Address - Street 1:91 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-1767
Practice Address - Country:US
Practice Address - Phone:770-536-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013267207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29354Medicare UPIN