Provider Demographics
NPI:1265599591
Name:LANDWEHR, LAWRENCE PAUL (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:PAUL
Last Name:LANDWEHR
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 1:407 A EAST RUSSELL AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-2958
Mailing Address - Country:US
Mailing Address - Phone:660-422-7000
Mailing Address - Fax:
Practice Address - Street 1:407 A. EAST RUSSELL AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:660-422-7000
Practice Address - Fax:660-747-0409
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD111733207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG06202Medicare UPIN
MOG06202Medicare UPIN