Provider Demographics
NPI:1295777456
Name:FOOTE, LAWRENCE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:FOOTE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:SUITE 740
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4519
Practice Address - Country:US
Practice Address - Phone:713-795-0202
Practice Address - Fax:713-799-8290
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6717207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128301207Medicaid
TX128301208Medicaid
TX128301203Medicaid
TX128301201Medicaid
TX8R1438OtherBLUE CROSS OF TEXAS
TX128301206Medicaid
TX87750KMedicare PIN
TX84Y144Medicare PIN
TX8752N2Medicare PIN
TX8R1438OtherBLUE CROSS OF TEXAS
TXE21209Medicare UPIN
TX128301206Medicaid