Provider Demographics
NPI:1245264969
Name:WALDROP, LAWRENCE GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GRANT
Last Name:WALDROP
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 1:3791 KATELLA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3105
Mailing Address - Country:US
Mailing Address - Phone:562-493-6461
Mailing Address - Fax:562-489-8489
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3105
Practice Address - Country:US
Practice Address - Phone:562-493-6461
Practice Address - Fax:562-489-8489
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist