Provider Demographics
NPI:1184696296
Name:SCHROCK, LAWRENCE G (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:G
Last Name:SCHROCK
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 1:910 W 5TH AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-252-2830
Mailing Address - Fax:509-252-2841
Practice Address - Street 1:105 W 8TH
Practice Address - Street 2:SUITE 7060
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-747-6194
Practice Address - Fax:509-747-4313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013929208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0189202OtherDEPT LABOR INDUSTRIES
WA1773803Medicaid
P00186286OtherRAILROAD MEDICARE
A07383Medicare UPIN
0189202OtherDEPT LABOR INDUSTRIES