Provider Demographics
NPI:1134209950
Name:LAWRENCE, MARY GILBERT (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GILBERT
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:420 DELAWARE ST SE MMC 493
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-4400
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB NINTH FLOOR, CLINIC 9A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-625-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39818207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08-00043OtherMEDICA-PRIMARY
MN123055OtherUCARE
MNHP28855OtherHEALTH PARTNERS
MT0055131Medicaid
MN822584OtherARAZ
MN07G31LAOtherBCBS
MN0807421OtherMEDICA-CHOICE
MN1019186OtherPREFERRED ONE
MN117549OtherFAIRVIEW
MN1019186OtherPREFERRED ONE