Provider Demographics
NPI:1245650720
Name:LAWRENCE S. AMESSE MD, PA
Entity type:Organization
Organization Name:LAWRENCE S. AMESSE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-545-2011
Mailing Address - Street 1:7837 VENTURE CENTER WAY
Mailing Address - Street 2:SUITE 5105
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7407
Mailing Address - Country:US
Mailing Address - Phone:937-545-2011
Mailing Address - Fax:937-458-5005
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:SUITE 6
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3724
Practice Address - Country:US
Practice Address - Phone:561-257-0816
Practice Address - Fax:561-257-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116927207VE0102X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG29497Medicare UPIN