Provider Demographics
NPI:1255955191
Name:KENNETH G. LAWLOR, DO, PLLC
Entity type:Organization
Organization Name:KENNETH G. LAWLOR, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-717-8838
Mailing Address - Street 1:3108 CLEARWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7170
Mailing Address - Country:US
Mailing Address - Phone:928-717-8838
Mailing Address - Fax:
Practice Address - Street 1:2060 W WHISPERING WIND DR STE 264
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2869
Practice Address - Country:US
Practice Address - Phone:623-235-6889
Practice Address - Fax:623-235-6877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty