Provider Demographics
NPI:1255383634
Name:LAWSON, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:LAWSON
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:DEPT LA 21693
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1693
Mailing Address - Country:US
Mailing Address - Phone:888-727-1070
Mailing Address - Fax:877-883-5176
Practice Address - Street 1:36320 INLAND VALLEY DR
Practice Address - Street 2:STE 101
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:951-600-3811
Practice Address - Fax:951-600-4493
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA814642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A814640Medicaid
CA00A814640OtherBCBS
CA00A814640Medicaid
CAAU937ZMedicare PIN
CA00A814640OtherBCBS
CAP00178728Medicare PIN