Provider Demographics
NPI:1336149152
Name:LAWRENCE, WILLIAM S (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:LAWRENCE
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 1:64-1035 MAMALAHOA HWY STE K
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8440
Mailing Address - Country:US
Mailing Address - Phone:808-883-9785
Mailing Address - Fax:808-887-0546
Practice Address - Street 1:64-1035 MAMALAHOA HWY STE K
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8440
Practice Address - Country:US
Practice Address - Phone:808-883-9785
Practice Address - Fax:808-887-0546
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06811102Medicaid
HID24692Medicare UPIN
HI06811102Medicaid